Sample records for care sensitive conditions

  1. [Hospitalisations for ambulatory care sensitive conditions in Germany

    NARCIS (Netherlands)

    Freund, T.; Heller, G.; Szecsenyi, J.


    BACKGROUND: On the basis of the assumption that a significant proportion of hospitalisations for so-called ambulatory care sensitive conditions (ACSCs) are potentially avoidable by ambulatory care measures, hospitalisation rates for ACSCs are used internationally as population based indicators for a

  2. Hospitalization for ambulatory care sensitive conditions and the role of primary care in Italian regions.

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    Aldo Rosano


    Full Text Available Abstract
    Background: Hospitalization may often be prevented by timely and effective outpatient care either by preventing the onset of an illness, controlling an acute illness or managing a chronic disease with an appropriate follow-up. The objective of the study is to examine the variability of hospital admissions within Italian regions for Ambulatory Care Sensitive Conditions (ACSCs, and their relationship with primary care supply.
    Methods: Hospital discharge data aggregated at a regional level collected in 2005 were analysed by type of ACS conditions. Main outcome measures were regional hospital admission rates for ACSCs. Negative binomial models were used to analyse the association with individual risk factors (age and gender and regional risk factors (propensity to hospitalisation and prevalence of specific conditions.
    Non-parametric correlation indexes between standardised hospital admission rates and quantitative measures of primary care services were calculated.
    Results: ACSC admissions accounted for 6.6% of total admissions, 35.7% were classified as acute conditions and 64.3% as chronic conditions. Admission rates for ACSCs varied widely across Italian regions with different patterns for chronic and acute conditions. Southern regions showed significantly higher rates for chronic conditions and North-eastern regions for acute conditions. We found a significant negative association between the provision of ambulatory specialist services and standardised hospitalization rates
    (SHR for ACS chronic conditions (r=-0.50; p=0.02 and an inverse correlation among SHR for ACS acute conditions and the rate of GPs per 1,000 residents, although the latter was not statistically significant.
    Conclusions: In Italy, about 480,000 inpatient hospital admissions in 2005 were attributable to ACSCs. Even
    adjusting for potential confounders


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    Maria Aparecida Araújo Figueiredo


    Full Text Available Objective:analyzethe extent to which the incidence rate of primary care sensitivehospitalizations in children under five years is influenced by the percentage of coverage of theprimary care.Methods:This was a cross-sectional ecological study that combines coverage ofprimary careand theambulatorycare-sensitiveconditionsin 2000 and 2010. We used data from theHospital Information System (HIS and the Information System of Primary Care (SIAB.Results:The data revealed that the increased coverage providedprimary carereductionrateofhospitalization diseases studied. In 2000 the reduction was greater for gastroenteritis (51% inchildren under 01 years and 30% in children 01-04 years in 2010 for respiratory diseases (51% inchildren under 01years and 33% in children aged 01-04 years.Conclusion:we found an association between the coverage ofprimary careand admission rates, however seem to affect othervariables, suggesting the need for further studies.

  4. Record of hospitalizations for ambulatory care sensitive conditions: validation of the hospital information system

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    Tania Cristina Morais Santa Barbara Rehem


    Full Text Available OBJECTIVE: to estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. METHOD: the hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. RESULT: the sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. CONCLUSION: there are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.

  5. Hospitalizations for ambulatory care-sensitive conditions, Minas Gerais, Southeastern Brazil, 2000 and 2010

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    Rita Maria Rodrigues-Bastos


    Full Text Available OBJECTIVE To analyze hospitalization rates and the proportion of deaths due to ambulatory care-sensitive hospitalizations and to characterize them according to coverage by the Family Health Strategy, a primary health care guidance program. METHODS An ecological study comprising 853 municipalities in the state of Minas Gerais, under the purview of 28 regional health care units, was conducted. We used data from the Hospital Information System of the Brazilian Unified Health System. Ambulatory care-sensitive hospitalizations in 2000 and 2010 were compared. Population data were obtained from the demographic censuses. RESULTS The number of ambulatory care-sensitive hospitalizations declined from 20.75/1,000 inhabitants [standard deviation (SD = 10.42 in 2000 to 14.92/thousand inhabitants (SD = 10.04 in 2010 Heart failure was the most frequent cause in both years. Hospitalizations rates for hypertension, asthma, and diabetes mellitus, decreased, whereas those for angina pectoris, prenatal and birth disorders, kidney and urinary tract infections, and other acute infections increased. Hospitalization durations and the proportion of deaths due to ambulatory care-sensitive hospitalizations increased significantly. CONCLUSIONS Mean hospitalization rates for sensitive conditions were significantly lower in 2010 than in 2000, but no correlation was found with regard to the expansion of the population coverage of the Family Health Strategy. Hospitalization rates and proportion of deaths were different between the various health care regions in the years evaluated, indicating a need to prioritize the primary health care with high efficiency and quality.

  6. Hospital admissions due to ambulatory care sensitive conditions among children by age group and health region

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    Kelly Holanda Prezotto


    Full Text Available OBJECTIVE to describe hospital admissions for ambulatory care sensitive conditions in children under five years of age in the State of Paraná, Brazil by condition type, age group and health region. METHOD a temporal ecological study was conducted using data from the Unified Health System Hospital Information System for the period 2000 to 2011. Conditions were grouped in accordance with the list of ambulatory care sensitive conditions in Brazil. RESULTS there was an increase in the rate of admissions for ambulatory care sensitive conditions in all age groups in 50% of the health regions, with a marked increase in children under the age of one. Pneumonia, gastroenteritis and asthma were the main causes of admissions. There was an increase in the proportion of overall admissions accounted for by pneumonia and gastroenteritis. CONCLUSION the increase in admissions reveals the need for actions to improve access to primary healthcare and provide effective treatment of the main ambulatory care sensitive conditions in order to prevent hospital admissions among children.

  7. Hospitalization for ambulatory care sensitive conditions at health insurance organization hospitals in Alexandria, Egypt. (United States)

    Mosallam, Rasha A; Guirguis, Wafaa W; Hassan, Mona Ha


    This study aimed at estimating the percentage of hospital discharges and days of care accounted for by Ambulatory Care Sensitive Conditions (ACSCs) at Health Insurance Organization (HIO) hospitals in Alexandria, calculating hospitalization rates for ACSCs among HIO population and identifying determinants of hospitalization for those conditions. A sample of 8300 medical records of patients discharged from three hospitals affiliated to HIO at Alexandria was reviewed. The rate of monthly discharges for ACSCs was estimated on the basis of counting number of combined ACSCs detected in the three hospitals and the hospitals' average monthly discharges. ACSCs accounted for about one-fifth of hospitalizations and days of care at HIO hospitals (21.8% and 20.8%, respectively). Annual hospitalization rates for ACSCs were 152.5 per 10,000 insured population. The highest rates were attributed to cellulitis/abscess (47.3 per 10,000 population), followed by diabetes complications and asthma (42.8 and 20.8 per 10,00 population). Logistic regression indicated that age, number of previous admissions, and admission department are significant predictors for hospitalization for an ACSC.

  8. Perceived Stress, Multimorbidity, and Risk for Hospitalizations for Ambulatory Care-sensitive Conditions

    DEFF Research Database (Denmark)

    Prior, Anders; Vestergaard, Mogens; Davydow, Dimitry S;


    BACKGROUND: Psychiatric disorders are associated with an increased risk for ambulatory care-sensitive condition (ACSC)-related hospitalizations, but it remains unknown whether this holds for individuals with nonsyndromic stress that is more prevalent in the general population. OBJECTIVES......: To determine whether perceived stress is associated with ACSC-related hospitalizations and rehospitalizations, and posthospitalization 30-day mortality. RESEARCH DESIGN AND MEASURES: Population-based cohort study with 118,410 participants from the Danish National Health Survey 2010, which included data...... on Cohen's Perceived Stress Scale, followed from 2010 to 2014, combined with individual-level national register data on hospitalizations and mortality. Multimorbidity was assessed using health register information on diagnoses and drug prescriptions within 39 condition categories. RESULTS: Being...

  9. Overview of hospitalizations by ambulatory care sensitive conditions in the municipality of Cotia, Brazil

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    Renata Laszlo Torres


    Full Text Available Objective To describe the profile of Hospitalizations by Amulatory Care Sensitive Conditions (HACSC, in the Municipality of Cotia, from 2008 to 2012. Method ecological, exploratory, longitudinal study with a quantitative approach. Data on HACSC, by age group and sex, were obtained from the Department of the Unified Health System. For data analysis descriptive statistics were used. Results During the period, there were 46,676 admissions, excluding deliveries, 7,753 (16.61% by HACSC. The main causes were cerebrovascular diseases, 16.96%, heart failure, 15.50%, hypertension, 10.80% and infection of the kidney and urinary tract, 10.51%. Regarding gender, HACSC occurred predominantly in males. There was a greater number of HACSC at extreme age ranges, especially in the elderly. Conclusion Chronic diseases predominate among the leading causes of HACSC and there was no significant difference between sex.

  10. Hospitalisations and costs relating to ambulatory care sensitive conditions in Ireland.

    LENUS (Irish Health Repository)

    Sheridan, A


    BACKGROUND: Ambulatory care sensitive conditions (ACSCs) are conditions for which the provision of timely and effective outpatient care can reduce the risks of hospitalisation by preventing, controlling or managing a chronic disease or condition. AIMS: The aims of this study were to report on ACSCs in Ireland, and to provide a baseline for future reference. METHODS: Using HIPE, via Health Atlas Ireland, inpatient discharges classified as ACSCs using definitions from the Victorian ACSC study were extracted for the years 2005-2008. Direct methods of standardisation allowed comparison of rates using the EU standard population as a comparison for national data, and national population as comparison for county data. Costs were estimated using diagnosis-related groups. RESULTS: The directly age-standardised discharge rate for ACSC-related discharges increased slightly, but non-significantly, from 15.40 per 1,000 population in 2005 to 15.75 per 1,000 population in 2008. The number of discharges increased (9.5%) from 63,619 in 2005 to 69,664 in 2008, with the estimated associated hospital costs increasing (31.5%) from 267.8 million in 2005 to 352.2 million in 2008. Across the country, there was considerable variation in the discharge rates for the Top-10 ACSCs for the years 2005-2008. Significantly lower rates of hospitalisation were observed in more urban areas including Cork, Dublin and Galway. The most common ACSC in 2008 was diabetes with complications (29.8%). CONCLUSIONS: The variation in rates observed indicates the scope of reducing hospitalisations and associated costs for ACSCs, across both adult\\'s and children\\'s services and particularly in relation to diabetes complications.

  11. Sensitive hospitalizations to primary care and care in the health care network

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    Pollyanna Kássia de Oliveira Borges


    Full Text Available Objective: to check the profile of sensitive causes hospitalizations for primary care. Methods: this is an ecological, epidemiological study. Data was collected in the Hospital Information System at the Department of Health System Information, grouped according to the admissions list for Sensitive to Primary Causes of Health System. Results: there were 227,014 hospitalizations, 25.8% of them were sensitive to Primary care. The illnesses which caused sensitive admissions were pneumonia (n=19,832; 33.7%, heart failure (n=6,688, 11.3%, and gastroenteritis (n=6,287, 10.7%. Conclusion: sensitive hospitalizations for primary care have decreasing historical trend in the study area. Primary care services, with guidelines and principles, well conducted could minimize the risk of exacerbation of chronic conditions and also endorse lower rates of infection transmitted diseases.

  12. Habituation, sensitization and Pavlovian conditioning

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    Münire Özlem Çevik


    Full Text Available In this brief review, I argue that the impact of a stimulus on behavioral control increase as the distance of the stimulus to the body decreases. Habituation, i.e., decrement in response intensity repetition of the triggering stimulus, is the default state for sensory processing, and the likelihood of habituation is higher for distal stimuli. Sensitization, i.e., increment in response intensity upon stimulus repetition, occurs in a state dependent manner for proximal stimuli that make direct contact with the body. In Pavlovian conditioning paradigms, the US is always a more proximal stimulus than the CS. The mechanisms of associative and non-associative learning are not independent. CS-US pairings lead to formation of associations if sensitizing modulation from a proximal US prevents the habituation for a distal anticipatory CS.

  13. Designing robots for care: care centered value-sensitive design. (United States)

    van Wynsberghe, Aimee


    The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship--what I refer to as care robots--require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What's more, given the stage of their development and lack of standards provided by the International Organization for Standardization to guide their development, ethics ought to be included into the design process of such robots. The manner in which this may be accomplished, as presented here, uses the blueprint of the Value-sensitive design approach as a means for creating a framework tailored to care contexts. Using care values as the foundational values to be integrated into a technology and using the elements in care, from the care ethics perspective, as the normative criteria, the resulting approach may be referred to as care centered value-sensitive design. The framework proposed here allows for the ethical evaluation of care robots both retrospectively and prospectively. By evaluating care robots in this way, we may ultimately ask what kind of care we, as a society, want to provide in the future.

  14. Designing Robots for Care: Care Centered Value-Sensitive Design



    The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship—what I refer to as care robots—require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What’s more, given the stage of their develo...

  15. How do states condition care chains?

    DEFF Research Database (Denmark)

    Spanger, Marlene; Dahl, Hanne Marlene; Petersson, Elin


    In investigating global and regional care chains, scholars have traditionally adopted a sociological bottom-up approach, but more attention has recently been focused on the role of the state. Despite this new attention to states and the ways in which they condition care chains, the existing...... frameworks cannot grasp the complexity of potential struggles and tensions within states and at the various levels of the state. In outlining a broad and tentative analytical framework for exploration of the role of the state in shaping global and regional care chains, this theoretical article combines...... discursive policy analysis with feminist state and multi-level governance theories. Paying attention to the role of the state, we focus on the framing of policy problems that are important for care chains and on potential tensions between different framings within a state and across the different levels...

  16. Culturally Sensitive Health Care and Counseling Psychology: An Overview (United States)

    Herman, Keith C.; Tucker, Carolyn M.; Ferdinand, Lisa A.; Mirsu-Paun, Anca; Hasan, Nadia T.; Beato, Cristina


    This article introduces the Major Contribution, which focuses on counseling psychologists' roles in addressing health disparities through culturally sensitive health care research and interventions. First, the authors provide a rationale for conducting research focused on culturally sensitive health care and then offer definitions of…

  17. Designing Robots for Care: Care Centered Value-Sensitive Design

    NARCIS (Netherlands)

    Wynsberghe, van A.


    The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship—what I refer to as care robots—require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vu

  18. The role of neurosciences intensive care in neurological conditions. (United States)

    Sadek, Ahmed-Ramadan; Damian, Maxwell; Eynon, C Andy


    The neurosciences intensive care unit provides specialized medical and nursing care to both the neurosurgical and neurological patient. This second of two articles describes the role it plays in the management of patients with neurological conditions.

  19. Are care plans suitable for the management of multiple conditions?


    Young, Charlotte E.; Boyle, Frances M; Allyson J Mutch


    Background: Care plans have been part of the primary care landscape in Australia for almost two decades. With an increasing number of patients presenting with multiple chronic conditions, it is timely to consider whether care plans meet the needs of patients and clinicians. Objectives: To review and benchmark existing care plan templates that include recommendations for comorbid conditions, against four key criteria: (i) patient preferences, (ii) setting priorities, (iii) identifying conflict...

  20. Sensitizing Young English Language Learners Towards Environmental Care (United States)

    Castillo, Rigoberto; Rojas, María del Pilar


    This paper reports an action research study aimed at understanding how to sensitize young English language learners towards caring for the environment. The pedagogical intervention in a 5th grade class consisted in the use of creative writing strategies to express learners' ideas. Three stages were followed: "recognizing facts,"…

  1. Care of Adult Refugees with Chronic Conditions. (United States)

    Terasaki, Genji; Ahrenholz, Nicole Chow; Haider, Mahri Z


    Refugees share a common experience of displacement from their country of origin, migration, and resettlement in an unfamiliar country. More than 17 million people have fled their home countries due to war, generalized violence, and persecution. US primary care physicians must care for their immediate and long-term medical needs. Challenges include (1) language and cultural barriers, (2) high rates of mental health disorders, (3) higher prevalence of latent infections, and (4) different explanatory models for chronic diseases. This article discusses management strategies for common challenges that arise in the primary care of refugees.

  2. Dependency in autonomous caring--night nurses' working conditions for caring in nursing. (United States)

    Gustafsson, Christine; Fagerberg, Ingegerd; Asp, Margareta


    Few research studies have focused on nurses' working conditions for caring provided at night, and these studies have mainly described nurses' work in hospital settings, not in a municipal, social-care context. In Swedish municipal care, nurses have responsibility for hundreds of older people in need of care. This working condition compromises caring encounters; instead the nurses' caring is mainly mediated through care staff (or relatives). In considering that caring based on caring encounters is fundamental to ethical nursing practice questions leads to the aim: to explore Swedish municipal night nurses' experiences of their working conditions for caring in nursing. All municipal night-duty nurses (n = 7) in a medium-sized community in Sweden participated in interviews, while six of them also wrote diaries. Thematic content analysis has been used in analysing the data. The findings revealed that the nurses experienced their working conditions for caring in nursing in the themes of Dependency in the Organisation and Other Staff, Vocational Responsibility, Deficiency in Conditions for Caring and Autonomous Caring. The findings illustrate privileged, as well as, poor working conditions for caring in nursing. The nurses' role as consultants emerge as their main function. The consultant function implies that nurses do not participate in ordinary bed-side caring, which makes it easier for them to find time for caring in situations that arise when nurses' skills, expertise and authority are called upon. Conversely the consultancy function entails short-term solution of complex caring problems, which can signify deficient caring due to prevailing working conditions. The findings also point to nurses' possible problems in fulfilling their own and vocational demands for ethics in the practice of caring in nursing related to existing working conditions.

  3. Impact of Chronic Conditions on the Cost of Cancer Care... (United States)

    U.S. Department of Health & Human Services — According to findings reported in Impact of Chronic Conditions on the Cost of Cancer Care for Medicaid Beneficiaries, published in Volume 2, Issue 4 of the Medicare...

  4. Sensitivity of a Simulated Derecho Event to Model Initial Conditions (United States)

    Wang, Wei


    Since 2003, the MMM division at NCAR has been experimenting cloud-permitting scale weather forecasting using Weather Research and Forecasting (WRF) model. Over the years, we've tested different model physics, and tried different initial and boundary conditions. Not surprisingly, we found that the model's forecasts are more sensitive to the initial conditions than model physics. In 2012 real-time experiment, WRF-DART (Data Assimilation Research Testbed) at 15 km was employed to produce initial conditions for twice-a-day forecast at 3 km. On June 29, this forecast system captured one of the most destructive derecho event on record. In this presentation, we will examine forecast sensitivity to different model initial conditions, and try to understand the important features that may contribute to the success of the forecast.

  5. On accurate boundary conditions for a shape sensitivity equation method (United States)

    Duvigneau, R.; Pelletier, D.


    This paper studies the application of the continuous sensitivity equation method (CSEM) for the Navier-Stokes equations in the particular case of shape parameters. Boundary conditions for shape parameters involve flow derivatives at the boundary. Thus, accurate flow gradients are critical to the success of the CSEM. A new approach is presented to extract accurate flow derivatives at the boundary. High order Taylor series expansions are used on layered patches in conjunction with a constrained least-squares procedure to evaluate accurate first and second derivatives of the flow variables at the boundary, required for Dirichlet and Neumann sensitivity boundary conditions. The flow and sensitivity fields are solved using an adaptive finite-element method. The proposed methodology is first verified on a problem with a closed form solution obtained by the Method of Manufactured Solutions. The ability of the proposed method to provide accurate sensitivity fields for realistic problems is then demonstrated. The flow and sensitivity fields for a NACA 0012 airfoil are used for fast evaluation of the nearby flow over an airfoil of different thickness (NACA 0015).

  6. Assessing decision quality in patient-centred care requires a preference-sensitive measure

    DEFF Research Database (Denmark)

    Kaltoft, Mette Kjer; Cunich, Michelle; Salkeld, Glenn;


    A theory-based instrument for measuring the quality of decisions made using any form of decision technology, including both decision-aided and unaided clinical consultations is required to enable person- and patient-centred care and to respond positively to individual heterogeneity in the value...... aspects of decision making. Current instruments using the term 'decision quality' have adopted a decision- and thus condition-specific approach. We argue that patient-centred care requires decision quality to be regarded as both preference-sensitive across multiple relevant criteria and generic across all...... conditions and decisions. MyDecisionQuality is grounded in prescriptive multi criteria decision analysis and employs a simple expected value algorithm to calculate a score for the quality of a decision that combines, in the clinical case, the patient's individual preferences for eight quality criteria...

  7. Palliative Care, Hospice, and Advance Care Planning: Views of People Living with HIV and Other Chronic Conditions. (United States)

    Slomka, Jacquelyn; Prince-Paul, Maryjo; Webel, Allison; Daly, Barbara J


    People living with HIV (PLWH) who survive to older adulthood risk developing multiple chronic medical conditions. Health policymakers recognize the role of early palliative care and advance care planning in improving health quality for at-risk populations, but misperceptions about palliative care, hospice, and advance care planning are common. Before testing a program of early palliative care for PLWH and other chronic conditions, we conducted focus groups to elicit perceptions of palliative care, hospice, and advance care planning in our target population. Overall, participants were unfamiliar with the term palliative care, confused concepts of palliative care and hospice, and/or associated hospice care with dying. Participants misunderstood advance care planning, but valued communication about health care preferences. Accepting palliative care was contingent on distinguishing it from hospice and historical memories of HIV and dying. Provision of high-quality, comprehensive care will require changing public perceptions and individuals' views in this high-risk population.

  8. Living In A Country With A Strong Primary Care System Is Beneficial To People With Chronic Conditions. (United States)

    Hansen, Johan; Groenewegen, Peter P; Boerma, Wienke G W; Kringos, Dionne S


    In light of the growing pressure that multiple chronic diseases place on health care systems, we investigated whether strong primary care was associated with improved health outcomes for the chronically ill. We did this by combining country- and individual-level data for the twenty-seven countries of the European Union, focusing on people's self-rated health status and whether or not they had severe limitations or untreated conditions. We found that people with chronic conditions were more likely to be in good or very good health in countries that had a stronger primary care structure and better coordination of care. People with more than two chronic conditions benefited most: Their self-rated health was higher if they lived in countries with a stronger primary care structure, better continuity of care, and a more comprehensive package of primary care services. In general, while having access to a strong primary care system mattered for people with chronic conditions, the degree to which it mattered differed across specific subgroups (for example, people with primary care-sensitive conditions) and primary care dimensions. Primary care reforms, therefore, should be person centered, addressing the needs of subgroups of patients while also finding a balance between structure and service delivery.

  9. A Atenção Primária à Saúde no sul de Santa Catarina: uma análise das internações por condições sensíveis à atenção ambulatorial, no período de 1999 a 2004 Primary Health Care in the south of Santa Catarina: analysis of admissions for ambulatory care-sensitive conditions, in the 1999-2004 period

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    Evelyn Elias


    ção adequada a sua magnitude foi muito menor. As taxas de internação por Acidente Vascular Cerebral foram crescentes em município com atenção adequada, com tênue queda linear para a população atendida de forma não adequada. Em relação às internações por Infarto Agudo do Miocárdio, tanto nos municípios com atenção adequada quanto naqueles com atenção não adequada, as taxas apresentaram tendência ao aumento, com tendência um pouco menor nos municípios com PSF adequado. CONCLUSÃO: É possível perceber algumas mudanças positivas na evolução de algumas taxas de internações por condições sensíveis à atenção ambulatorial, que podem estar associadas a maior cobertura e a melhor atenção recebida pelo PSF.INTRODUCTION: The reorientation of the health care model in Brazil is based on a strategy to structure a primary care network to cover the health needs of the population through access to family health teams. The impact of primary care on the health of the population can be assessed by tracking hospital admissions due to conditions sensitive to ambulatory care, an initiative that has been developed in recent years in several countries and also in Brazil OBJECTIVE: To analyze hospital admission trends for some conditions sensitive to ambulatory care in the Association of Cities of the South End of Santa Catarina - AMESC, associating it to the quality of care offered by the Family Health Program-PSF METHOD: An exploratory research with characteristics of an ecological study that qualified the primary care offered, based on a questionnaire directed to PSF professionals and information collected through national data information, defining two population groups: one assisted by services with a basic standard and another one assisted by services below this standard. Hospital admissions for some selected causes of these two populations were compared in the 1999-2004 period, analyzing their trend and statistical association. RESULTS: The statistical

  10. Parametric estimation of medical care costs under conditions of censoring


    Raikou, Maria; McGuire, Alistair


    This paper is concerned with a set of parametric estimators that attempt to provide consistent estimates of average medical care costs under conditions of censoring. The main finding is that incorporation of the inverse of the probability of an individual not being censored in the estimating equations is instrumental in deriving unbiased cost estimates. The success of the approach is dependent on the amount of available information on the cost history process. The value of this information in...

  11. Assessment of access to primary health care among children and adolescents hospitalized due to avoidable conditions

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    Ana Paula Scoleze Ferrer

    Full Text Available Introduction: Hospitalizations for ambulatory care-sensitive conditions (HACSC are considered an indicator of the effectiveness of primary health care (PHC. High rates of HACSC represent problems in the access or the quality of health care. In Brazil, HACSC rates are high and there are few studies on the factors associated with it. Objective: To evaluate the access to PHC offered to children and adolescents hospitalized due to ACSC and analyze the conditioning factors. Method: Cross-sectional study with a quantitative and qualitative approach. Five hundred and one (501 users (guardians/caregivers and 42 professionals of PHC units were interviewed over one year. Quantitative data were obtained using Primary Care Assessment Tool validated in Brazil (PCATool-Brazil, while qualitative data were collected by semi-structured interview. The independent variables were: age, maternal education, family income, type of diagnosis, and model of care offered, and the dependent variables were access and its components (accessibility and use of services. Results: Sixty-five percent (65.2% of hospitalizations were ACSC. From the perspective of both users and professionals, access and its components presented low scores. Age, type of diagnosis, and model of care affected the results. Conclusion: The proportion of HACSC was high in this population. Access to services is inappropriate due to: barriers to access, appreciation of the emergency services, and attitude towards health needs. Professional attitudes and opinions reinforce inadequate ideas of users reflecting on the pattern of service use.

  12. Conceptual and methodological aspects in the study of hospitalizations for ambulatory care sensitive conditions Aspectos conceituais e metodológicos no estudo das hospitalizações por condições sensíveis à atenção primária

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    Fúlvio Borges Nedel


    Full Text Available Hospitalization rates for Ambulatory Care Sensitive Conditions have been used to assess effectiveness of the first level of health care. From a critical analysis of related concepts, we discuss principles for selecting a list of codes and, taking the example of the Brazilian Family Health Program, propose a methodological pathway for identifying variables in order to inform statistical models of analysis. We argue that for the indicator to be comparable between regions, disease codes should be selected based on sensitivity and specificity principles, not on observed disease frequency. Rates of hospitalization will be determined, at a distal level, by the socio-economic environment and their effect on the social and demographic structure. Timely and effective care depends on the organization of health services, their availability and access barriers, which depend on the ways health and related technology are conceptualised and on their adherence to the biomedical model or to the Primary Health Care (PHC principles; performance indicators of the health system will be the proximal determinants. This indicator is potentially useful for primary care evaluation. The historical reconstruction of PHC improves the analysis of the indicator variability.As taxas de hospitalização por condições sensíveis à atenção primária são um indicador da efetividade do primeiro nível de atenção à saúde. Partindo de breve revisão crítica, este artigo discute princípios para a seleção de códigos de internação por essas causas e, com o exemplo do Programa Saúde da Família, propõe um modelo teórico para a seleção de variáveis para análise estatística. A comparabilidade inter-regional do indicador depende da seleção de códigos de doenças baseada em princípios de sensibilidade e especificidade, não na frequência da doença. As taxas de hospitalização serão distalmente determinadas pela situação socioeconômica e seu efeito sobre a

  13. Concordance between nurse-reported quality of care and quality of care as publicly reported by nurse-sensitive indicators

    NARCIS (Netherlands)

    D. Stalpers (Dewi); R.A.M.M. Kieft (Renate A. M. M.); D. van der Linden (Dimitri); M.J. Kaljouw (Marian J.); M.J. Schuurmans (Marieke )


    textabstractBackground: Nurse-sensitive indicators and nurses' satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-s

  14. Sensitivity of African easterly waves to boundary layer conditions

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    A. Lenouo


    Full Text Available A linearized version of the quasi-geostrophic model (QGM with an explicit Ekman layer and observed static stability parameter and profile of the African easterly jet (AEJ, is used to study the instability properties of the environment of the West African wave disturbances. It is found that the growth rate, the propagation velocity and the structure of the African easterly waves (AEW can be well simulated. Two different lower boundary conditions are applied. One assumes a lack of vertical gradient of perturbation stream function and the other assumes zero wind perturbation at the surface. The first case gives more realistic results since in the absence of horizontal diffusion, growth rate, phase speed and period have values of 0.5 day−1, 10.83 m s−1 and 3.1 day, respectively. The zero wind perturbation at the surface case leads to values of these parameters that are 50 percent lower. The analysis of the sensitivity to diffusion shows that the magnitude of the growth rate decreases with this parameter. Modelled total relative vorticity has its low level maximum around 900 hPa under no-slip, and 700 hPa under free slip condition.

  15. Culture and religion in nursing: providing culturally sensitive care. (United States)

    Mendes, Aysha

    Last month, Aysha Mendes discussed the impact on care of personal beliefs held by both nurses and patients. This month, she delves into the aspects of culture and religion, which form important pieces of this puzzle, as well as the importance of culturally appropriate care provision in nursing practice.

  16. Hospitalizações por condições sensíveis à atenção primária nos municípios em gestão plena do sistema no Estado do Rio Grande do Sul, Brasil Hospitalization for primary care sensitive conditions in municipalities with full local health management control in Rio Grande do Sul State, Brazil

    Directory of Open Access Journals (Sweden)

    Juvenal Soares Dias-da-Costa


    Full Text Available Avaliou-se a qualidade dos cuidados oferecidos nos municípios em gestão plena no Rio Grande do Sul, Brasil, por meio da taxa de internações hospitalares por condições sensíveis à atenção primária, no período de 1995 a 2005. Foram consideradas as internações hospitalares por: diabetes mellitus, insuficiência cardíaca, hipertensão arterial, doença pulmonar obstrutiva crônica e doenças imunopreveníveis em indivíduos na faixa etária de 20 a 59 anos. Verificou-se diminuição das taxas em quase todos os municípios do estado. A regressão de Poisson não mostrou tendências de diminuição das taxas após a adesão à gestão plena. Nos municípios menores, as taxas foram mais elevadas. As internações por condições sensíveis à atenção ambulatorial mostraram-se indicadores de fácil operação e de baixo custo que podem produzir conhecimentos sobre os sistemas de saúde, possibilitando a melhoria de sua qualidade.We assess the quality of care provided in the cities with full health system management, in the state of Rio Grande do Sul, Brazil, by means of the rate of hospitalizations for primary care sensitive conditions, between 1995 and 2005. The following were considered as hospitalizations for sensitive conditions: diabetes mellitus, heart failure, hypertension, chronic obstructive pulmonary disease and immunopreventive diseases in individuals aged between 20 and 59 years. Findings reveal that, beginning in 2001, there has been a reduction in rates in almost all cities. Through the Poisson regression we didn't observe a lower rates after the full health system management. Among cities with full health system management, rates of hospitalizations for ambulatory care sensitive conditions increased as the population size decreased. Hospitalizations for ambulatory care sensitive conditions were found to be low-cost, easily-operated indicators and can produce knowledge about health systems, enabling their quality

  17. Noise sensitivity and reactions to noise and other environmental conditions

    NARCIS (Netherlands)

    Miedema, H.M.E.; Vos, H.


    This article integrates findings from the literature and new results regarding noise sensitivity. The new results are based on analyses of 28 combined datasets (N=23 038), and separate analyses of a large aircraft noise study (N=10939). Three topics regarding noise sensitivity are discussed, namely,

  18. Caregivers in older peoples' care: perception of quality of care, working conditions, competence and personal health. (United States)

    From, Ingrid; Nordström, Gun; Wilde-Larsson, Bodil; Johansson, Inger


    The aim was to describe and compare nursing assistants', enrolled nurses' and registered nurses' perceptions of quality of care, working conditions, competence and personal health in older peoples' care. Altogether 70 nursing assistants, 163 enrolled nurses and 198 registered nurses completed a questionnaire comprising Quality from the Patient's Perspective modified for caregivers, Creative Climate Questionnaire, Stress of Conscience Questionnaire, items on education and competence and Health Index. The caregivers reported higher perceived reality of quality of care in medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere. In subjective importance, the highest rating was assessed in one of the physical-technical items. The organisational climate was for three of the dimensions rather close/reached the value for a creative climate, for seven dimensions close to a stagnant climate. In perceived stress of conscience, there were low values. Nursing assistants had lower values than enrolled nurses and registered nurses. The caregivers reported highest values regarding previous education making them feel safe at work and lowest value on the item about education increasing the ability for a scientific attitude. Registered nurses could use knowledge in practice and to a higher degree than nursing assistants/enrolled nurses reported a need to gain knowledge, but the latter more often received education during working hours. The health index among caregivers was high, but registered nurses scored lower on emotional well-being than nursing assistants/enrolled nurses. The caregivers' different perceptions of quality of care and work climate need further attention. Although stress of conscience was low, it is important to acknowledge what affected the caregivers work in a negative way. Attention should be paid to the greater need for competence development among registered nurses during working hours.

  19. Spanning boundaries and creating strong patient relationships to coordinate care are strategies used by experienced chronic condition care coordinators. (United States)

    Ehrlich, Carolyn; Kendall, Elizabeth; Muenchberger, Heidi


    People with complex chronic conditions frequently need to navigate their own way through and around a fragmented and siloed health care system. Care coordination is a defining principle of primary care and is frequently proposed as a solution to this problem. However, care coordination requires more time and effort than primary care physicians alone have the capacity to deliver. Although registered nurses (RNs) are skilled team members who can be included in the delivery of coordinated patient care, any model of care coordination that involves RNs needs to fit within the existing health care delivery system. In this study, which used qualitative techniques based on grounded theory and included face-to-face interviews and open coding and theoretical sampling until data saturation was achieved, and which was one component of a larger action research study, we aimed to gain an understanding of the difference between usual chronic condition care and the work of chronic condition care coordination. The researchers interviewed general practitioners and RNs from various general practice sites who were actively coordinating care. Four unique processes were found to define care coordination implementation, namely: (1) moving beyond usual practice by spanning boundaries; (2) relationship-based care; (3) agreed roles and routines among relevant parties; and (4) committing to chronic condition care coordination. The findings suggested that existing professional and organisational cultures required negotiation before care coordination could be integrated into existing contexts. The challenge, however, seems to be in acknowledging and overcoming professional practice boundaries that define existing care through reflective practice and shared resourcing.

  20. Nonmaternal Care's Association With Mother's Parenting Sensitivity: A Case of Self-Selection Bias? (United States)

    Nomaguchi, Kei M; Demaris, Alfred


    Although attachment theory posits that the use of nonmaternal care undermines quality of mothers' parenting, empirical evidence for this link is inconclusive. Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 1,233), the authors examined the associations between nonmaternal care characteristics and maternal sensitivity during the first 3 years of children's lives, with special attention to selection effects and moderation by resource levels. Findings from fixed-effects regression models suggested that, on average, there is little relationship between nonmaternal care characteristics and maternal sensitivity, once selection factors are held constant. Some evidence of moderation effects was found, however. Excellent-quality care is related to more sensitivity for mothers with lower family income. Poor-quality care is related to lower sensitivity for single mothers, but not partnered mothers. In sum, nonmaternal care characteristics do not seem to have as much influence on mothers' parenting as attachment theory claims.

  1. Sensitive Measures of Condition Change in EEG Data

    Energy Technology Data Exchange (ETDEWEB)

    Hively, L.M.; Gailey, P.C.; Protopopescu, V.


    We present a new, robust, model-independent technique for measuring condition change in nonlinear data. We define indicators of condition change by comparing distribution functions (DF) defined on the attractor for time windowed data sets via L{sub 1}-distance and {chi}{sup 2} statistics. The new measures are applied to EEG data with the objective of detecting the transition between non-seizure and epileptic brain activity in an accurate and timely manner. We find a clear superiority of the new metrics in comparison to traditional nonlinear measures as discriminators of condition change.

  2. Clinical exchange: one model to achieve culturally sensitive care. (United States)

    Scholes, J; Moore, D


    This paper reports on a clinical exchange programme that formed part of a pre-registration European nursing degree run by three collaborating institutions in England, Holland and Spain. The course included: common and shared learning including two summer schools; and the development of a second language before the students went on a three-month clinical placement in one of the other base institutions' clinical environments. The aim of the course was to enable students to become culturally sensitive carers. This was achieved by developing a programme based on transcultural nursing principles in theory and practice. Data were gathered by interview, focus groups, and questionnaires from 79 exchange students, fostering the strategies of illuminative evaluation. The paper examines: how the aims of the course were met; the factors that inhibited the attainment of certain goals; and how the acquisition of a second language influenced the students' learning about nursing. A model is presented to illustrate the process of transformative learning from the exchange experience.

  3. Computational Fluid Dynamics Based Investigation of Sensitivity of Furnace Operational Conditions to Burner Flow Controls

    Energy Technology Data Exchange (ETDEWEB)

    Marc Cremer; Kirsi St. Marie; Dave Wang


    This is the first Semiannual Technical Report for DOE Cooperative Agreement No: DE-FC26-02NT41580. The goal of this project is to systematically assess the sensitivity of furnace operational conditions to burner air and fuel flows in coal fired utility boilers. Our approach is to utilize existing baseline furnace models that have been constructed using Reaction Engineering International's (REI) computational fluid dynamics (CFD) software. Using CFD analyses provides the ability to carry out a carefully controlled virtual experiment to characterize the sensitivity of NOx emissions, unburned carbon (UBC), furnace exit CO (FECO), furnace exit temperature (FEGT), and waterwall deposition to burner flow controls. The Electric Power Research Institute (EPRI) is providing co-funding for this program, and instrument and controls experts from EPRI's Instrument and Controls (I&C) Center are active participants in this project. This program contains multiple tasks and good progress is being made on all fronts. A project kickoff meeting was held in conjunction with NETL's 2002 Sensors and Control Program Portfolio Review and Roadmapping Workshop, in Pittsburgh, PA during October 15-16, 2002. Dr. Marc Cremer, REI, and Dr. Paul Wolff, EPRI I&C, both attended and met with the project COR, Susan Maley. Following the review of REI's database of wall-fired coal units, the project team selected a front wall fired 150 MW unit with a Riley Low NOx firing system including overfire air for evaluation. In addition, a test matrix outlining approximately 25 simulations involving variations in burner secondary air flows, and coal and primary air flows was constructed. During the reporting period, twenty-two simulations have been completed, summarized, and tabulated for sensitivity analysis. Based on these results, the team is developing a suitable approach for quantifying the sensitivity coefficients associated with the parametric tests. Some of the results of the CFD

  4. Relationship among eye condition sensitivities,photosensitivity and epileptic syndromes

    Institute of Scientific and Technical Information of China (English)

    YANG Zhi-xian; CAI Xiang; LIU Xiao-yan; QIN Jiong


    Background Electroencephalogram(EEG)activity in normal subjects and epileptic patients is often closely related to the eye's status such as eye opened(EO),eye closure(ECL)and eyes closed(EC).ECL is the period immediately after closing of the eyes and only Iasts for Jess than 3 seconds if the eyes remain closed.EC is the pened as long as the eyes are closed.Epileptiform changes on EEG induced by ECL or EC are called the changes of ECL sensitivity(ECLS)or EC sensitivity (ECS).ECLS occurs mainly but not exclusively in photosensitive patients and ECS has been seen rarely in photosensitive patients.This study aimed to investigate the relationships among ECLS,ECS.photosensitivity and epilepsy syndromes in children.Methods EEG records from child patients in the EEG Department of Peking University First Hospital dudng the period of May 2005 to Mav 2007 were examined for the presence of ECLS or ECS.Open-close eye tests and intermittent photic stimulations were carried out during video-EEG monitoring for examining ECLS.ECS and photosensitivity.Results Based on ECLS and ECS on their EEGs,30 patients were divided into ECLS group (16 cases)and ECS group (14 cases).There were more boys than girls in the two groups.The mean age of initial detection of ECLS and ECS was 10 years.and the average onset age of seizures was 9 years.The epilepsy syndromes in the ECLS group included idiopathic photosensitive occipital lobe epilepsy,Panayiotopoulos syndrome,symptomatic occipital lobe epilepsy,juvenile myoclonic epilepsy,juvenile absence epilepsy,eyelid myoclonia with absences,epilepsy with grand mal on awakening and pure photosensitive epilepsy with mainly generalized tonic clonic seizures.Those in the ECS group were iuvenile myoclonic epilepsy,idiopathic photosensitive occipital Iobe epilepsy,Panayiotopoulos syndrome and Gastaut type-idiclpathic children occipital epilepsy.Photosensitivity was detected in 88%of Patients with ECLS and 29%of patients with ECS.Conclusions ECLS and ECS are

  5. Musculoskeletal conditions in children and adolescents managed in Australian primary care


    Henschke, Nicholas; Harrison, Christopher; McKay, Damien; Broderick, Carolyn; Latimer, Jane; Britt, Helena; Maher, Christopher G


    Background Primary care settings play a vital role in the early detection and appropriate management of musculoskeletal conditions in paediatric populations. However, little data exist regarding these conditions in a primary care context or on the presentation of specific musculoskeletal disorders in children. The aim of this study was to estimate the caseload and describe typical management of musculoskeletal conditions in children and adolescents presenting to primary care in Australia. Met...

  6. Neonatal Intensive Care and Child Psychiatry Inpatient Care: Do Different Working Conditions Influence Stress Levels?

    Directory of Open Access Journals (Sweden)

    Evalotte Mörelius


    Full Text Available Introduction. Nurses often experience work-related stress. High stress can negatively affect job satisfaction and lead to emotional exhaustion with risk of burnout. Aim. To analyse possible differences in biological stress markers, psychosocial working conditions, health, and well-being between nurses working in two different departments. Methods. Stress was evaluated in nurses working in a neonatal intensive care unit (NICU (n=33 and nurses working in a child and adolescent psychiatry inpatient ward (CAP (n=14 using salivary cortisol and HbA1c. Salivary cortisol was measured three times a day on two consecutive days during two one-week periods, seven weeks apart (= 12 samples/person. Psychosocial working conditions, health, and well-being were measured once. Results. NICU nurses had better social support and more self-determination. CAP nurses had a lower salivary cortisol quotient, poorer general health, and higher client-related burnout scores. Conclusion. When comparing these nurses with existing norm data for Sweden, as a group their scores reflect less work-related stress than Swedes overall. However, the comparison between NICU and CAP nurses indicates a less healthy work situation for CAP nurses. Relevance to Clinical Practice. Healthcare managers need to acknowledge the less healthy work situation CAP nurses experience in order to provide optimal support and promote good health.

  7. Programa Saúde da Família e condições sensíveis à atenção primária, Bagé (RS Programa Salud de la Familia y condiciones sensibles a la atención primaria, Sur de Brasil Family Health Program and ambulatory care-sensitive conditions in Southern Brazil

    Directory of Open Access Journals (Sweden)

    Fúlvio Borges Nedel


    familia, ser usuaria del Programa Salud de la Familia, consulta médica en la emergencia en el mes anterior a la investigación y hospital de internación; b hombres: rango de edad, haber sufrido otra internación en el año anterior a la entrevista y el hospital de internación. CONCLUSIONES: Las condiciones sensibles a la atención primaria permiten identificar grupos carentes de atención a la salud adecuada. A pesar de que el estudio no permita hacer inferencias sobre el riesgo de internación, los análisis por sexo y modelo de atención sugieren que el programa Salud de la Familia es más equitativo que la atención básica tradicional.OBJECTIVE: Ambulatory care-sensitive conditions (ACSC are health problems managed by actions at the first level of care. The need for hospitalization by these causes is avoidable through an effective and proper primary health care. The objective of the study was to estimate ACSC among patients hospitalized by the Sistema Único de Saúde (Brazilian Health System. METHODS: Hospital-based cross-sectional study involving 1,200 inhabitants of Bagé (Southern Brazil who were inpatients between September/2006 and January/2007. The patients answered a questionnaire applied by interviewers and were classified according to the model of attention utilized prior to hospitalization. ACSC were defined in a workshop promoted by the Ministry of Health. The variables analyzed included demographic and socioeconomic characteristics, health and health services utilized. Multivariate analysis was conducted by the Poisson model, according to a hierarchical conceptual framework, stratified by sex and model of care. RESULTS: ACSC accounted for 42.6% of the hospitalizations. The probability that the main diagnosis for hospitalization is considered an ACSC is greater among women, children under five years of age, individuals with less then five years of schooling, hospitalization in the year prior to the interview, emergency room consultation, and being an

  8. The role of neurosciences intensive care in trauma and neurosurgical conditions. (United States)

    Sadek, Ahmed-Ramadan; Eynon, C Andy


    The creation of neurosciences intensive care units was born out of the awareness that a group of neurological and neurosurgical patients required specialized intensive medical and nursing care. This first of two articles describes the role of neurosciences intensive care in the management of trauma and neurosurgical conditions.

  9. 75 FR 37187 - Patient Protection and Affordable Care Act: Preexisting Condition Exclusions, Lifetime and Annual... (United States)


    ... Protection and Affordable Care Act; Requirements for Group Health Plans and Health Insurance Issuers Under the Patient Protection and Affordable Care Act Relating to Preexisting Condition Exclusions, Lifetime... CFR Parts 144, 146, and 147 RIN 0991-AB69 Patient Protection and Affordable Care Act:...

  10. Patient Priority-Directed Decision Making and Care for Older Adults with Multiple Chronic Conditions. (United States)

    Tinetti, Mary E; Esterson, Jessica; Ferris, Rosie; Posner, Philip; Blaum, Caroline S


    Older adults with multiple conditions receive care that is often fragmented, burdensome, and of unclear benefit. An advisory group of patients, caregivers, clinicians, health system engineers, health care system leaders, payers, and others identified three modifiable contributors to this fragmented, burdensome care: decision making and care focused on diseases, not patients; inadequate delineation of roles and responsibilities and accountability among clinicians; and lack of attention to what matters to patients and caregivers (ie, their health outcome goals and care preferences). The advisory group identified patient priority-directed care as a feasible, sustainable approach to addressing these modifiable factors.

  11. 42 CFR 494.90 - Condition: Patient plan of care. (United States)


    ... clinical practice standard for adequacy of dialysis. (2) Nutritional status. The interdisciplinary team must provide the necessary care and counseling services to achieve and sustain an effective nutritional... is a change in transplant candidate status. (d) Standard: Patient education and training. The...

  12. 42 CFR 494.100 - Condition: Care at home. (United States)


    ... to home patients must ensure through its interdisciplinary team, that home dialysis services are at... part. (a) Standard: Training. The interdisciplinary team must oversee training of the home dialysis... the home patient's care by a member of the dialysis facility's interdisciplinary team....

  13. 42 CFR 482.57 - Condition of participation: Respiratory care services. (United States)


    ... be adequate numbers of respiratory therapists, respiratory therapy technicians, and other personnel... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Respiratory care... HOSPITALS Optional Hospital Services § 482.57 Condition of participation: Respiratory care services....

  14. Experiences of care planning in England: interviews with patients with long term conditions

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    Newbould Jenny


    Full Text Available Abstract Background The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority in England for chronic disease management. However, it is not clear how care planning is currently understood, translated and implemented in primary care. This study explores experience of care planning in patients with long term conditions in three areas in England. Methods We conducted semi-structured interviews with 23 predominantly elderly patients with multiple long term conditions. The interviews were designed to explore variations in and emergent experiences of care planning. Qualitative analysis of interview transcripts involved reflexively coding and re-coding data into categories and themes. Results No participants reported experiencing explicit care planning discussions or receiving written documentation setting out a negotiated care plan and they were unfamiliar with the term ‘care planning’. However, most described some components of care planning which occurred over a number of contacts with health care professionals which we term”reactive” care planning. Here, key elements of care planning including goal setting and action planning were rare. Additionally, poor continuity and coordination of care, lack of time in consultations, and patient concerns about what was legitimate to discuss with the doctor were described. Conclusions Amongst this population, elements of care planning were present in their accounts, but a structured, comprehensive process and consequent written record (as outlined in English Department of Health policy was not evident. Further research needs to explore the advantages and disadvantages of different approaches to care planning for different patient groups.

  15. Generalizing the Sensitivity Conditions in an Overall Index of Product Quality.



    The issue of the sensitivity of weighted linear composites to attribute-importance weights has attracted researchers from various disciplines, including marketing, psychology, and statistics. At issue is how sensitive a weighted scale is to a particular choice of weights. Scale sensitivity is defined by a negative correlation between two scales. By considering the general case of "n" attributes and using an algebraic approach, the authors specify the precise sufficiency conditions under which...

  16. Expectations outpace reality: physicians' use of care management tools for patients with chronic conditions. (United States)

    Carrier, Emily; Reschovsky, James


    Use of care management tools--such as group visits or patient registries--varies widely among primary care physicians whose practices care for patients with four common chronic conditions--asthma, diabetes, congestive heart failure and depression--according to a new national study by the Center for Studying Health System Change (HSC). For example, less than a third of these primary care physicians in 2008 reported their practices use nurse managers to coordinate care, and only four in 10 were in practices using registries to keep track of patients with chronic conditions. Physicians also used care management tools for patients with some chronic conditions but not others. Practice size and setting were strongly related to the likelihood that physicians used care management tools, with solo and smaller group practices least likely to use care management tools. The findings suggest that, along with experimenting with financial incentives for primary care physicians to adopt care management tools, policy makers might consider developing community-level care management resources, such as nurse managers, that could be shared among smaller physician practices.

  17. Practical strategies for providing culturally sensitive, ethical care in developing nations. (United States)

    Crigger, Nancy J; Holcomb, Lygia


    Providing health care in developing nations results in cultural and ethical challenges for health care professionals. The authors' intent is to raise readers' awareness of how to maintain an ethical and culturally sensitive approach to practice in developing nations. Four practical approaches to ethical decision-making, developed from the literature and praxis, in conjunction with traditional moral theory and guidelines from professional and international organizations are discussed. Ethical multiculturalism, a view that combines universalism and multiculturalism undergirds culturally appropriate and ethically responsive decisions.

  18. Care and Solidarity Are Conditions for Interventionist Research

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    Max Liboiron


    Full Text Available Calls for interventionist research in academic disciplines, including science and technology studies (STS, are increasingly common. Yet none offer insights for what to do or whom to turn to after a researcher has intervened and the result is slander, defaming, or disenfranchisement—even though these are possible, and even likely, results of intervening in controversies and power struggles. Drawing from the ethics and methods used in direct action activism, I argue that intentional networks of care and solidarity are necessary supports that need to be in place before we call for interventionist research.

  19. Development of an Inventory for Health-Care Office Staff to Self-Assess Their Patient-Centered Cultural Sensitivity

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    Carolyn M. Tucker


    Full Text Available Background: Patient-centered culturally sensitive health care (PC-CSHC is a best practice approach for improving health-care delivery to culturally diverse populations and reducing health disparities. Despite patients’ report that cultural sensitivity by health-care office staff is an important aspect of PC-CSHC, the majority of available research on PC-CSHC focuses exclusively on health-care providers. This may be due in part to the paucity of instruments available to assess the cultural sensitivity of health-care office staff. The objective of the present study is to determine the psychometric properties of the Tucker-Culturally Sensitive Health Care Office Staff Inventory-Self-Assessment Form (T-CSHCOSI-SAF. This instrument is designed to enable health-care office staff to self-assess their level of agreement that they display behaviors and attitudes that culturally diverse patients have identified as office staff cultural sensitivity indicators. Methods: A sample of 510 health-care office staff were recruited at 67 health-care sites across the United States. These health-care office staff anonymously completed the T-CSHCOSI-SAF and a demographic data questionnaire. Results and Level of Evidence: Confirmatory factor analyses of the T-CSHCOSI-SAF revealed that this inventory has 2 factors with high internal consistency reliability (Cronbach’s αs= .916 and .912. Conclusion and Implications: The T-CSHCOSI-SAF is a useful inventory for health-care office staff to assess their own level of patient-centered cultural sensitivity. Such self-assessment data can be used in the development and implementation of trainings to promote patient-centered cultural sensitivity of health-care office staff and to help draw the attention of these staff to displaying patient-centered cultural sensitivity.

  20. The Burnout Condition of Primary Health Care Personnel

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    Mehmet Kaya


    Full Text Available The concept of burnout was first introduced by Fredeunberger in 1974. Fredeunberger had stated that burnout occurred more commonly in occupations whose members directly work with people. The aim of the study is to examine the burnout status of primary health care staff. The universe of this descriptive study is 466 health staff who work in primary health care units in Kecioren. The participation of the study was 54%. A Questionnaire including Maslach Burnout Inventory (MBI and some characteristics of the participants were used for data collection. Mann-whitney U and Kruskal Wallis tests have been used for analizing the survey data. Seventyseven percent of the participants were female and the emotional exhaustion score of female was higher than male (p<0.01. The age of the participants effect the individual achievement scores (p<0.01. The profession or marital status of the participants didn’t affect the MBI scores. Some socio-demografic characteristics of the participants such as gender and age, affect the scores of MBI. Comprehensive studies which display the causes of problems, needed in this issue. [TAF Prev Med Bull. 2007; 6(5: 357-363

  1. An Innovative Approach to Health Care Delivery for Patients with Chronic Conditions (United States)

    Bourn, Scott; Skoufalos, Alexis; Beck, Eric H.; Castillo, Daniel J.


    Abstract Although the health care reform movement has brought about positive changes, lingering inefficiencies and communication gaps continue to hamper system-wide progress toward achieving the overarching goal—higher quality health care and improved population health outcomes at a lower cost. The multiple interrelated barriers to improvement are most evident in care for the population of patients with multiple chronic conditions. During transitions of care, the lack of integration among various silos and inadequate communication among providers cause delays in delivering appropriate health care services to these vulnerable patients and their caregivers, diminishing positive health outcomes and driving costs ever higher. Long-entrenched acute care-focused treatment and reimbursement paradigms hamper more effective deployment of existing resources to improve the ongoing care of these patients. New models for care coordination during transitions, longitudinal high-risk care management, and unplanned acute episodic care have been conceived and piloted with promising results. Utilizing existing resources, Mobile Integrated Healthcare is an emerging model focused on closing these care gaps by means of a round-the-clock, technologically sophisticated, physician-led interprofessional team to manage care transitions and chronic care services on-site in patients' homes or workplaces. PMID:27563751


    Directory of Open Access Journals (Sweden)



    Full Text Available OBJECTIVES: To outline the spectrum of bacteria causing pneumonia and the pattern of antimicrobial sensitivity in outpatients with pneumonia in a tertiary care hospital in Himachal Pradesh. METHODS: Sputum of 108 immuno competent pneumonia patients attending outpatient departments of Medicine and Pulmonary medicine of Dr. R. P. Government Medical College , Kangra at Tanda was sent for Gram staining and culture and sensitivity testing. RESULTS: Commensals were detected in most of the cases (32 , 29.6% followed by Staphylococcus aureus in 17(15.7% and Streptococcus pneumoniae in 16(14.8%. This was followed by three Gram negative organisms namely E Coli (11 , 10.2% , Pseudomonas (10 , 9.2% and Klebsiella (8 , 7.2%. No growth was obtained in 7(6.5% and other organisms were isolated in 7(6.5% specimens. Staphylococcus aureus was sensitive to vancomycin , clindamycin , cefoxitin , azithromycin and cotrimoxazole. Streptococcus pneumoniae was found to be sensitive to vancomycin , clindamycin , gentamicin , azithromycin , penicillin , cotrimoxazole , amoxicillin +clavulanic acid. Klebsiella was found to be sensitive to imipenem , azithromycin , ciprofloxacin , gentamicin and amoxicillin +clavulanic acid. E coli was sensitive to imipenem , gentamicin and amoxicillin +clavulanic acid. Pseudomonas aeruginosa was found to be sensitive to gentamicin , cefta zidime , imipenem , ticarcillin and piperacillin. CONCLUSION: Staphylococcus aureus and Streptococcus pneumoniae are the commonest organism causing pneumonia. Streptococcus pneumoniae is resistant to many antibiotics. Azithromycin can be the first line therapy for pneumonia.

  3. Talking about sensitive topics during the advance care planning discussion: A peek into the black box

    DEFF Research Database (Denmark)

    Andreassen, Pernille; Neergaard, Mette Asbjørn; Brogaard, Trine;


    OBJECTIVE: Advance care planning (ACP) discussions are emphasized as a valuable way of improving communication about end-of-life care. Yet we have very little knowledge of what goes on during actual ACP discussions. The aim of our study was to explore how the sensitive topics of end-of-life......, and a physician, carried out in connection with a pilot study conducted in Denmark. RESULTS: Previous studies of directly observed patient-physician discussions about end-of-life care show largely ineffective communication, where end-of-life issues are toned down by healthcare professionals, who also tend...... choices. Patients actively explored different topics and asked questions about their current situation, but some also challenged the concept of ACP, especially the thought of being able to take control of end-of-life issues in advance. SIGNIFICANCE OF RESULTS: Our analysis indicates that during...

  4. Health care expenditures associated with pediatric pain-related conditions in the United States. (United States)

    Groenewald, Cornelius B; Wright, Davene R; Palermo, Tonya M


    The primary objective of this study was to assess the impact of pediatric pain-related conditions on health care expenditures. We analyzed data from a nationally representative sample of 6- to 17-year-old children captured in the 2007 National Health Interview Survey and 2008 Medical Expenditure Panel Survey. Health care expenditures of children with pain-related conditions were compared with those of children without pain-related conditions. Pain-related conditions were associated with incremental health care expenditures of $1339 (95% confidence interval [CI], $248-$2447) per capita. Extrapolated to the nation, pediatric pain-related conditions were associated with $11.8 billion (95% CI, $2.18-$21.5 billion) in total incremental health care expenditures. The incremental health care expenditures associated with pediatric pain-related conditions were similar to those of attention deficit and hyperactivity disorder ($9.23 billion; 95% CI, $1.89-$18.1 billion), but more than those associated with asthma ($5.35 billion; 95% CI, $0-$12.3 billion) and obesity ($0.73 billion; 95% CI, $6.28-$8.81 billion). Health care expenditures for pediatric pain-related conditions exert a considerable economic burden on society. Efforts to prevent and treat pediatric pain-related conditions are urgently needed.

  5. Hospitalizações por condições cardiovasculares sensíveis à atenção primária em municípios goianos Internaciones por condiciones cardiovasculares sensibles de Atención Primaria en municipios de centro-oeste de Brasil Hospitalizations due to primary care-sensitive cardiovascular conditions in municipalities of Central-West Brazil

    Directory of Open Access Journals (Sweden)

    Sandro Rogério Rodrigues Batista


    Condiciones de Vida y Salud y cobertura de Estrategia Salud de la Familia. La cobertura poblacional potencial de la Salud de la Familia fue calculada conforme a las directrices del Ministerio de la Salud. La variabilidad de las tasas fue evaluada según la prueba de t y ANOVA. RESULTADOS: Ocurrieron 253.254 internaciones (17,2% del total por condiciones cardiovasculares sensibles de la atención primaria. Las tasas de hospitalización disminuyeron entre los trienios: A (213,5, de=104,6; B (199,7, de=96,3 y C (150,2, de=76,1, con diferencia entre los períodos A-C y B-C (pOBJECTIVE: To analyze rates of hospitalization due to primary care-sensitive cardiovascular conditions. METHODS: This ecological study on 237 municipalities in the state of Goiás, Central-West Brazil, between 2000 and 2008, used data from the Hospital Information System and the Primary Care Information System. The hospitalization rates were calculated as the ratio between the number of hospitalizations due to cardiovascular conditions and the population over the age of 40 years. The data were evaluated over the three-year periods A (2000-2002, B (2003-2005 and C (2006-2008, according to sex, age group, population size, whether the individual belonged to the metropolitan region, healthcare macroregion, distance from the state capital, living conditions index and coverage within the Family Health Strategy. The potential population coverage of the Family Health Strategy was calculated in accordance with Ministry of Health guidelines. The variability of the rates was evaluated using the t test and ANOVA. RESULTS: A total of 253,254 hospitalizations (17.2% occurred due to primary care-sensitive cardiovascular conditions. The hospitalization rates diminished between the three-year periods: A (213.5, SD = 104.6, B (199.7, SD = 96.3 and C (150.2, SD = 76.1, with differences from A to C and from B to C (p < 0.001. Municipal population size did not influence the behavior of the rates. Municipalities near the state

  6. Measuring health outcomes of a multidisciplinary care approach in individuals with chronic environmental conditions using an abbreviated symptoms questionnaire

    Directory of Open Access Journals (Sweden)

    Roy Fox


    Full Text Available Roy Fox1, Tara Sampalli1, Jonathan Fox11Nova Scotia Environmental Health Centre, Fall River, NS, CanadaAbstract: The Nova Scotia Environmental Health Centre is a treatment facility for individuals with chronic environmental conditions such as multiple chemical sensitivity, chronic fatigue syndrome, fibromyalgia, chronic respiratory conditions and in some cases chronic pain. The premise of care is to provide a patient-centred multidisciplinary care approach leading to self-management strategies. In order to measure the outcome of the treatment in these complex problems, with overlapping diagnoses, symptoms in many body systems and suspected environmental triggers, a detailed symptoms questionnaire was developed specifically for this patient population and validated. Results from a pilot study in which an abbreviated symptoms questionnaire based on the top reported symptoms captured in previous research was used to measure the efficacy of a multidisciplinary care approach in individuals with multiple chemical sensitivity are presented in this paper. The purpose of this study was to examine the extent, type and patterns of changes over time in the top reported symptoms with treatment measured using the abbreviated symptoms questionnaire. A total of 183 active and 109 discharged patients participated in the study where the health status was measured at different time periods of follow up since the commencement of treatment at the Centre. The findings from this study were successful in generating an initial picture of the nature and type of changes in these symptoms. For instance, symptoms such as difficulty concentrating, sinus conditions and tiredness showed early improvement, within the first 6 months of being in treatment, while others, such as fatigue, hoarseness or loss of voice, took longer while others showed inconsistent changes warranting further enquiry. A controlled longitudinal study is planned to confirm the findings of the pilot study

  7. [Home care in a culturally sensitive environment: perspectives of caregivers of Haitian elderly patients and relatives]. (United States)

    Ducharme, Francine; Paquet, Mario; Vissandjée, Bilkis; Carpentier, Normand; Lévesque, Louise; Trudeau, Denise


    In Canada, the care provided by families occurs in an increasingly multiethnic context. Against this backdrop, the present qualitative study aims to explore the needs/expectations and solutions not only of (female) natural caregivers of an elderly relative hailing from Haiti (presented in terms of tracking cases) but also of remunerated home care providers - all with a view to developing a culturally sensitive service offering. As such, this study works from a conceptual framework centring on the negotiation of a common area of agreement between the stakeholders involved (i.e., natural caregivers and home care providers). To this end, focus groups and individual interviews were conducted among 15 caregivers and 37 home care providers. The three recurrent themes emerging from the data analysis concern, in context, the needs/expectations and solutions surrounding the experience of service use, barriers to use, and the relationships between natural caregivers and home care providers. The statements of both groups evidenced a consistency of views and have thus provided a basis for developing some recommendations acceptable to all stakeholders from the perspective of making culturally-based adjustments to the service offering.

  8. What is conditional event algebra and why should you care? (United States)

    Goodman, I. R.; Mahler, Ronald P. S.; Nguyen, H. T.


    Building practical intelligent-system algorithms requires appropriate tools for capturing the basic features of highly complex real-world environments. One of the most important of these tools, probability theory, is a calculus of events (e.g. EVENT = 'A fire-control radar of type A is detected' with Prob(EVENT) = 0.80). Conditional Event Algebra (CEA) is a relatively new inference calculus which rigorously extends standard probability theory to include events which are contingent--e.g. rules such as `If fire-control radar A is detected, then weapon B will be launched'; or conditionals such as `observation Z given target state X.' CEA allows one to (1) probabilistically model a contingent event; (2) assign a probability Prob(COND_EVENT) equals 0.50 to it; and (3) compute with such conditional events and probabilities using the same basic rules that govern ordinary events and probabilities. Since CEA is only about ten years old, it has achieved visibility primarily among specialists in expert-systems theory and mathematical logic. Recently, however, it has become clear that CEA has potentially radical implications for engineering practice as well. The purpose of this paper is to bring this promising new tool to the attention of the wider engineering community. We will give a tutorial introduction to CEA, based on simple motivational examples, and describe its potential applications in a number of practical engineering problems.

  9. Using online health communities to deliver patient-centered care to people with chronic conditions

    NARCIS (Netherlands)

    Eijk, M. van der; Faber, M.J.; Aarts, J.W.M.; Kremer, J.A.M.; Munneke, M.; Bloem, B.R.


    BACKGROUND: Our health care system faces major threats as the number of people with multiple chronic conditions rises dramatically. OBJECTIVE: To study the use of Online Health Communities (OHCs) as a tool to facilitate high-quality and affordable health care for future generations. METHODS: OHCs ar

  10. Clusterin and chemotherapy sensitivity under normoxic and graded hypoxic conditions in colorectal cancer.

    LENUS (Irish Health Repository)

    Kevans, David


    In vitro studies have shown that clusterin modulates treatment sensitivity in a number of human cancers; however, the interaction between clusterin expression and hypoxia in controlling treatment response in CRC has not previously been examined. The aim of this study was to assess the effect of clusterin overexpression in CRC cells on sensitivity to 5-fluorouracil (5-FU), oxaliplatin and FOLFOX treatment under normoxic and graded hypoxic conditions.

  11. Intercultural communication between patients and health care providers: an exploration of intercultural communication effectiveness, cultural sensitivity, stress, and anxiety. (United States)

    Ulrey, K L; Amason, P


    Cultural diversity is becoming increasingly more important in the workplace. This is particularly true in health care organizations facing demographic shifts in the patients served and their families. This study serves to aid the development of intercultural communication training programs for health care providers by examining how cultural sensitivity and effective intercultural communication, besides helping patients, personally benefit health care providers by reducing their stress. Effective intercultural communication and cultural sensitivity were found to be related. Health care providers' levels of intercultural anxiety also were found to correlate with effective intercultural communication.

  12. Dutch care innovation units in elderly care: A qualitative study into students' perspectives and workplace conditions for learning. (United States)

    Snoeren, Miranda; Volbeda, Patricia; Niessen, Theo J H; Abma, Tineke A


    To promote workplace learning for staff as well as students, a partnership was formed between a residential care organisation for older people and several nursing faculties in the Netherlands. This partnership took the form of two care innovation units; wards where qualified staff, students and nurse teachers collaborate to integrate care, education, innovation and research. In this article, the care innovation units as learning environments are studied from a student perspective to deepen understandings concerning the conditions that facilitate learning. A secondary analysis of focus groups, held with 216 nursing students over a period of five years, revealed that students are satisfied about the units' learning potential, which is formed by various inter-related and self-reinforcing affordances: co-constructive learning and working, challenging situations and activities, being given responsibility and independence, and supportive and recognisable learning structures. Time constraints had a negative impact on the units' learning potential. It is concluded that the learning potential of the care innovation units was enhanced by realising certain conditions, like learning structures and activities. The learning potential was also influenced, however, by the non-controllable and dynamic interaction of various elements within the context. Suggestions for practice and further research are offered.

  13. Health conditions of elderly in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Cenir Gonçalves Tier


    Full Text Available This study aimed to identify the health conditions and environmental factors that influence the activities of daily living of elderly people. Cross-sectional epidemiological research conducted with 167 elderly in a municipality of Rio Grande do Sul, Brazil, from May to July 2013, using a structured instrument. Data were grouped for statistical/descriptive treatment. Circulatory diseases were the most frequent. The commonly used drug was aspirin, and falls were prevalent in 65 elderly. There was a significant difference in eating in age group older than 80 years (p=0,002. Dressing had significance in the age group above 80 years old (p=0.010, but was not significant when associated architecture with age. It was concluded that knowledge of the socio-demographic and health characteristics of the elderly enables the implementation of specific actions by health professionals, besides helping managers to formulate health indicators.

  14. In vitro sensitivity of Acinetobacter baumannii and Pseudomonas aeruginosa to carbapenems among intensive care unit patients. (United States)

    Guzek, A; Korzeniewski, K; Nitsch-Osuch, Aneta; Rybicki, Z; Prokop, E


    Acinetobacter baumannii and Pseudomonas aeruginosa pathogens are the most common causes of fatal pneumonia among patients treated in Intensive Care Units (ICU). Carbapenems remain a group of antibiotics characterized by the highest effectiveness in treatment of heavy infections of the lower respiratory tract. This study compared in vitro sensitivity of A. baumannii and P. aeruginosa to three carbapenems: imipenem, meropenem and doripenem. The material was collected from 71 patients treated in the ICU from April 2009 to January 2010. Bronchial tree was the predominant source of samples. Fifty-four strains of A. baumannii and 17 strains of P. aeruginosa were analyzed. Sensitivity to carbapenems was interpreted in line with Clinical and Laboratory Standard Institute (CLSI) and European Committee for Antimicrobial Susceptibility Testing (EUCAST) criteria (imipenem and meropenem) or in compliance with the Food and Drug Administration (FDA) and CLSI guidelines (doripenem). We found that A. baumannii was significantly more often sensitive to imipenem than to doripenem and meropenem, but only according to the CLSI and FDA and not EUCAST criteria. The sensitivity of P. aeruginosa was higher to imipenem than to doripenem and meropenem, according to both CLSI and EUCAST criteria (64.7 %). We conclude that the EUCAST criteria demonstrate a higher rigor than those of CLSI and FDA in the determination of carbapenems sensitivity. Imipenem appears more effective than doripenem and meropenem in treatment of A. baumannii and P. aeruginosa infections.

  15. Setting standards at the forefront of delivery system reform: aligning care coordination quality measures for multiple chronic conditions. (United States)

    DuGoff, Eva H; Dy, Sydney; Giovannetti, Erin R; Leff, Bruce; Boyd, Cynthia M


    The primary study objective is to assess how three major health reform care coordination initiatives (Accountable Care Organizations, Independence at Home, and Community-Based Care Transitions) measure concepts critical to care coordination for people with multiple chronic conditions. We find that there are major differences in quality measurement across these three large and politically important programs. Quality measures currently used or proposed for these new health reform-related programs addressing care coordination primarily capture continuity of care. Other key areas of care coordination, such as care transitions, patient-centeredness, and cross-cutting care across multiple conditions are infrequently addressed. The lack of a comprehensive and consistent measure set for care coordination will pose challenges for healthcare providers and policy makers who seek, respectively, to provide and reward well-coordinated care. In addition, this heterogeneity in measuring care coordination quality will generate new information, but will inhibit comparisons between these care coordination programs.

  16. Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping

    Directory of Open Access Journals (Sweden)

    Tara Sampalli


    Full Text Available Background Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely – an adaptation of Value Stream Mapping (VSM to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding. Methods Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times. Results The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province. Conclusion Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions.

  17. Sensitivity and specificity of point-of-care rapid combination syphilis-HIV-HCV tests.

    Directory of Open Access Journals (Sweden)

    Kristen L Hess

    Full Text Available New rapid point-of-care (POC tests are being developed that would offer the opportunity to increase screening and treatment of several infections, including syphilis. This study evaluated three of these new rapid POC tests at a site in Southern California.Participants were recruited from a testing center in Long Beach, California. A whole blood specimen was used to evaluate the performance of the Dual Path Platform (DPP Syphilis Screen & Confirm, DPP HIV-Syphilis, and DPP HIV-HCV-Syphilis rapid tests. The gold-standard comparisons were Treponema pallidum passive particle agglutination (TPPA, rapid plasma reagin (RPR, HCV enzyme immunoassay (EIA, and HIV-1/2 EIA.A total of 948 whole blood specimens were analyzed in this study. The sensitivity of the HIV tests ranged from 95.7-100% and the specificity was 99.7-100%. The sensitivity and specificity of the HCV test were 91.8% and 99.3%, respectively. The treponemal-test sensitivity when compared to TPPA ranged from 44.0-52.7% and specificity was 98.7-99.6%. The non-treponemal test sensitivity and specificity when compared to RPR was 47.8% and 98.9%, respectively. The sensitivity of the Screen & Confirm test improved to 90.0% when cases who were both treponemal and nontreponemal positive were compared to TPPA+/RPR ≥ 1 ∶ 8.The HIV and HCV on the multi-infection tests showed good performance, but the treponemal and nontreponemal tests had low sensitivity. These results could be due to a low prevalence of active syphilis in the sample population because the sensitivity improved when the gold standard was limited to those more likely to be active cases. Further evaluation of the new syphilis POC tests is required before implementation into testing programs.

  18. Primary Care Sensitive Hospitalization: users detect flaws on the access to services

    Directory of Open Access Journals (Sweden)

    Tania Cristina Morais Santa Barbara Rehem


    Full Text Available The aim of this study is to analyze and understand the reasons for the occurrence of sensitive hospitalizations in accordance with users. Qualitative study conducted with users who were admitted to Pedreira General Hospital, in São Paulo. The data was collected through semi structured interviews and thereafter, transcribed and processed in the electronic program Alceste. When analyzing the content, the access was seized fundamentally as an empirical category, bringing up problems that later deserved, from the Brazilian Ministry of Health, a specific Program to improve the quality and access to primary care. The hierarchical and pyramidal organization shape from the health system in the city of São Paulo can be one of the important aspects for the access matter and established as an important restricting factor in the primary care role in reducing or even preventing the occurrence of these hospitalizations.

  19. Premiums for Long-Term Care Insurance Packages: Sensitivity with Respect to Biometric Assumptions

    Directory of Open Access Journals (Sweden)

    Ermanno Pitacco


    Full Text Available Long-term care insurance (LTCI covers are rather recent products, in the framework of health insurance. It follows that specific biometric data are scanty; pricing and reserving problems then arise because of difficulties in the choice of appropriate technical bases. Different benefit structures imply different sensitivity degrees with respect to changes in biometric assumptions. Hence, an accurate sensitivity analysis can help in designing LTCI products and, in particular, in comparing stand-alone products to combined products, i.e., packages including LTCI benefits and other lifetime-related benefits. Numerical examples show, in particular, that the stand-alone cover is much riskier than all of the LTCI combined products that we have considered. As a consequence, the LTCI stand-alone cover is a highly “absorbing” product as regards capital requirements for solvency purposes.

  20. Gluten sensitivity: problems of an emerging condition separate from celiac disease. (United States)

    Brown, Amy C


    Gluten sensitivity appears to be emerging as a separate condition from celiac disease, yet no clear definition or diagnosis exists. As a result, patients with gluten sensitivity experience delayed diagnosis and continuing symptoms if they consume gluten. This emerging medical problem may involve human genetics, plant genetic modifications, gluten as a food additive, environmental toxins, hormonal influences, intestinal infections and autoimmune diseases. The treatment is similar to that for celiac disease - a gluten-free diet. The use of a gluten-free diet or an elimination diet is encouraged in assisting people to determine whether or not they are gluten sensitive. It is time to not only recognize, but to treat and further research gluten sensitivity, as unconfirmed environmental factors continue to spread this problem further into the general population.

  1. Individualized Health Care Plans: Supporting Children With Chronic Conditions in the Classroom (United States)

    Hopkins, Amanda F.; Hughes, Mary-alayne


    Due to the major advances in technology and the sciences, advances in the medical treatment options for children with chronic conditions are being made at an astonishing rate. In the health care field, "children with chronic conditions" is a generic phrase that typically refers to children with physical, developmental, behavioral, or…

  2. Moving from evidence to practice: Models of care for the prevention and management of musculoskeletal conditions. (United States)

    Speerin, Robyn; Slater, Helen; Li, Linda; Moore, Karina; Chan, Madelynn; Dreinhöfer, Karsten; Ebeling, Peter R; Willcock, Simon; Briggs, Andrew M


    With musculoskeletal conditions now identified as the second highest cause of the morbidity-related global burden of disease, models of care for the prevention and management of disability related to musculoskeletal conditions are an imperative. Musculoskeletal models of care aim to describe how to operationalise evidence-based guidelines for musculoskeletal conditions and thus support implementation by clinical teams and their health systems. This review of models of care for musculoskeletal pain conditions, osteoarthritis, rheumatoid arthritis, osteoporosis and musculoskeletal injuries and trauma outlines health system and local implementation strategies to improve consumer outcomes, including supporting access to multidisciplinary teams, improving access for vulnerable populations and levering digital technologies to support access and self-management. However, the challenge remains of how to inform health system decision-makers and policy about the human and fiscal benefits for broad implementation across health services. Recommendations are made for potential solutions, as well as highlighting where further evidence is required.

  3. The Effect of Physician Delegation to Other Health Care Providers on the Quality of Care for Geriatric Conditions (United States)

    Lichtenstein, Brian J.; Reuben, David B.; Karlamangla, Arun S.; Han, Weijuan; Roth, Carol P.; Wenger, Neil S.


    OBJECTIVES to examine the effects of delegation on quality of care that patients receive for three common geriatric conditions: dementia, falls, and incontinence. DESIGN pooled analysis of 8 the Assessing Care of Vulnerable Elders (ACOVE) projects from 1998 to 2010. SETTING 15 ambulatory practice sites across the United States PARTICIPANTS 4,776 patients age ≥ 65 years, of mixed demographic backgrounds who participated in ACOVE studies. INTERVENTION multivariate analysis of prior ACOVE observation and intervention studies was conducted, with in addition to two retrospectively defined variables: “intent to delegate” and “maximum delegation” for each ACOVE quality indicator (QI). MEASUREMENTS The primary outcome for the study was QI pass probability, by level of delegation, for 47 ACOVE quality indicators. RESULTS A total of 4,776 patients were evaluated, with 16,204 QIs included for analysis. Across all studies, QI pass probabilities were 0.36 for physician-performed tasks; 0.55 for nurse practitioner (NP), physician assistant (PA), and registered nurse (RN)-performed tasks; and 0.61 for medical assistant (MA), or licensed vocational nurse (LVN)-performed tasks. In multiply adjusted models, the independent pass-probability effect of delegation to NPs, PAs, or RNs was 1.37 (p = 0.055) CONCLUSIONS Delegation to non-physician providers is associated with higher quality of care for geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions among older adults. PMID:26480977

  4. Occupational care giving conditions and human rights: A study of elderly caregivers in Botswana

    Directory of Open Access Journals (Sweden)

    Simon Kangethe


    Full Text Available The article aims to explore and discuss the occupational care giving conditions pitting them against human rights. The article′s objective is to initiate discussions and generate literature pertaining to occupational care giving load and assessing the human rights challenge it poses. The article uses analysis of the literature review from an array of eclectic data sources. The following factors were found besetting the caregivers′ human rights: (1 Aging; (2 Cultural and community attitudes towards care giving; (3 Risk of contagion; (4 Health hazards and lack of compensation. Recommendations: (1 Adoption of grandparents/grandchildren care symbiosis system; (2 Government remuneration policy for caregivers; (3 Mainstreaming of gender education to encourage men and youth develop an interest in care giving; (4 Institution of laws and policies by countries to provide for the compensation of caregivers′ occupational hazards and risks.

  5. Redução das internações por condições sensíveis à atenção primária no Brasil entre 1998-2009 Reducción de las internaciones por condiciones susceptibles a atención primaria en Brasil entre 1998-2009 Reduction of ambulatory care sensitive conditions in Brazil between 1998 and 2009

    Directory of Open Access Journals (Sweden)

    Antonio Fernando Boing


    temporales con datos secundarios relacionados con las Internaciones Hospitalarias por condiciones susceptibles a atención primaria en el Sistema Único de Salud de Brasil. Los datos fueron obtenidos del Sistema de Informaciones Hospitalarias. Las tasas de internaciones por 10.000 habitantes fueron estandarizadas por grupo etario y sexo, considerando la población brasileña masculina recensada en 2000 como patrón. El análisis de tendencia de la serie histórica fue realizado por regresión linear generalizado por el método de Prais-Winsten. RESULTADOS: Hubo reducción en el promedio anual de internaciones por condiciones susceptibles a atención primaria de 3,7% entre hombres (IC95% -2,3;-5,1 y mujeres (IC95% -2,5;-5,6 entre 1998 y 2009. La tendencia varió en cada unidad federativa, sin embargo, en ninguna hubo aumento de las internaciones. En el sexo masculino y femenino las mayores reducciones fueron observadas en las internaciones por úlceras gastrointestinales (-11,7% al año y -12,1%, respectivamente, condiciones evitables (-8,8% y -8,9% y enfermedades de las vías aéreas inferiores (-8,0% y -8,1%. Angina (hombres, infección en el riñón y tracto urinario (hombres y mujeres y condiciones relacionados al prenatal y parto (mujeres presentaron aumento en las internaciones. Los tres grupos de enfermedades que más ocasionaron internaciones fueron gastroenteritis infecciosas y complicaciones, internaciones por insuficiencia cardíaca y asma. CONCLUSIONES: Hubo reducción sustancial en las internaciones por condiciones susceptibles a atención primaria en Brasil entre 1998 y 2009, sin embargo, algunas enfermedades presentaron estabilidad o aumento, exigiendo atención del sector salud.OBJECTIVE: To describe the trends in hospitalizations for ambulatory care sensitive conditions between 1998 and 2009 in Brazil. METHODS: The ecological time series study used secondary data on hospitalizations for ACSC in the Sistema Único de Saúde (SUS, National Unified Health System

  6. The Affordable Care Act's pre-existing condition insurance plan: enrollment, costs, and lessons for reform. (United States)

    Hall, Jean P; Moore, Janice M


    The Pre-Existing Condition Insurance Plan (PCIP) is the temporary, federal high-risk pool created under the Affordable Care Act to provide coverage to uninsured individuals with preexisting conditions until 2014, when exchange coverage becomes avail­able to them. Nearly 78,000 people have enrolled since the program was implemented two years ago. This issue brief compares the PCIP with state-based high-risk pools that existed prior to the Affordable Care Act and considers programmatic differences that may have resulted in lower-than-anticipated enrollment and higher-than-anticipated costs for the PCIP. PCIP coverage, like state high-risk pool coverage, likely remains unaffordable to most lower-income individuals with preexisting conditions, but provides much needed access to care for those able to afford it. Operational costs of these programs are also quite high, making them less than optimal as a means of broader coverage expansion.

  7. Experience of primary care among homeless individuals with mental health conditions. (United States)

    Chrystal, Joya G; Glover, Dawn L; Young, Alexander S; Whelan, Fiona; Austin, Erika L; Johnson, Nancy K; Pollio, David E; Holt, Cheryl L; Stringfellow, Erin; Gordon, Adam J; Kim, Theresa A; Daigle, Shanette G; Steward, Jocelyn L; Kertesz, Stefan G


    The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA), one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366) were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005), with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H) questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score). Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons' needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers.

  8. Experience of primary care among homeless individuals with mental health conditions.

    Directory of Open Access Journals (Sweden)

    Joya G Chrystal

    Full Text Available The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA, one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366 were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005, with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score. Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons' needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers.

  9. Comparison of winter wheat yield sensitivity to climate variables under irrigated and rain-fed conditions (United States)

    Xiao, Dengpan; Shen, Yanjun; Zhang, He; Moiwo, Juana P.; Qi, Yongqing; Wang, Rende; Pei, Hongwei; Zhang, Yucui; Shen, Huitao


    Crop simulation models provide alternative, less time-consuming, and cost-effective means of determining the sensitivity of crop yield to climate change. In this study, two dynamic mechanistic models, CERES (Crop Environment Resource Synthesis) and APSIM (Agricultural Production Systems Simulator), were used to simulate the yield of wheat ( Triticum aestivum L.) under well irrigated (CFG) and rain-fed (YY) conditions in relation to different climate variables in the North China Plain (NCP). The study tested winter wheat yield sensitivity to different levels of temperature, radiation, precipitation, and atmospheric carbon dioxide (CO2) concentration under CFG and YY conditions at Luancheng Agro-ecosystem Experimental Stations in the NCP. The results from the CERES and APSIM wheat crop models were largely consistent and suggested that changes in climate variables influenced wheat grain yield in the NCP. There was also significant variation in the sensitivity of winter wheat yield to climate variables under different water (CFG and YY) conditions. While a temperature increase of 2°C was the threshold beyond which temperature negatively influenced wheat yield under CFG, a temperature rise exceeding 1°C decreased winter wheat grain yield under YY. A decrease in solar radiation decreased wheat grain yield under both CFG and YY conditions. Although the sensitivity of winter wheat yield to precipitation was small under the CFG, yield decreased significantly with decreasing precipitation under the rainfed YY treatment. The results also suggest that wheat yield under CFG linearly increased by ≈3.5% per 60 ppm (parts per million) increase in CO2 concentration from 380 to 560 ppm, and yield under YY increased linearly by ≈7.0% for the same increase in CO2 concentration.

  10. Is there a risk of sensitization and allergy to chlorhexidine in health care workers?

    DEFF Research Database (Denmark)

    Garvey, L H; Roed-Petersen, J; Husum, B


    BACKGROUND: In Denmark, chlorhexidine is the standard disinfectant in most hospitals and health care workers are repeatedly exposed to it. The aim of this study was to establish whether there is a risk of sensitization and allergy to chlorhexidine from this type of exposure. METHODS: Two hundred...... with chlorhexidine gluconate 1% and chlorhexidine acetate 1% were performed looking for type IV (delayed type) allergy. A prick test with chlorhexidine gluconate 0.5% and an intradermal test with chlorhexidine 0.0002% were performed looking for type I (immediate type) allergy. RESULTS: There were no positive tests...... in any of the 104 individuals tested (99% confidence interval 0-4.9%). There was a predominance of females in both groups and the overall median age was 42 years (28-63). No one in the group not tested reported to have a verified or suspected allergy to chlorhexidine. CONCLUSION: In this first study...

  11. Evaluating sociodemographic and medical conditions of patients under home care service

    Directory of Open Access Journals (Sweden)

    Tolga Önder


    Full Text Available Objective: In our study, we aimed to reveal medical conditions and the sociodemographic conditions of patients under home care service. Methods: Our study is planned on 52 patients who are under home care service at Sarıkamış State Hospital between June 2013 and May 2014. Patients' sex, education, social security status, comorbid diseases and general health status were recorded. Results: Fifty-two patients enrolled. 21 of them (40.4% were men, 31 of them (59.6 % were women. It is revealed that In 36 patients (69.2% did not receive formal education throughout their lives, while16 (30.8% of them had only primary education. All female patients were housewives. The most frequent diseases in home care patients were cerebrovascular disease in 18 (34.6% subjects, Alzheimer's disease in 9 (17.3%, and chronic obstructive pulmonary disease in 4 (7.7% d. 38 patients (73.1% needed routine follow-up. Most of the patients (61.5% had green card health insurance. Only 6 patients (11.5% were in need of narcotic analgesics. Thirteen patients had pressure ulcers due to immobilization. Evaluating the exercise capacity of the patients; 43 (82.7% could not dressed themselves, 38 (73.1% could not use phone. Thirty-two patients had urinary incontinence and 31 had fecal incontinence. Conclusion: Today, population of patients who need home care service is increasing due to ease access to home care service and increase in survival. For a better care of patients, home care providers should be well educated and differences on features of patients and medical conditions it should be taken into consideration.

  12. Antibiotic sensitivity pattern of bacterial pathogens in the intensive care unit of Fatmawati Hospital, Indonesia

    Institute of Scientific and Technical Information of China (English)

    Maksum Radji; Siti Fauziah; Nurgani Aribinuko


    Objective: To evaluate the sensitivity pattern of bacterial pathogens in the intensive care unit (ICU) of a tertiary care of Fatmawati Hospital Jakarta Indonesia. Methods: A cross sectional retrospective study of bacterial pathogen was carried out on a total of 722 patients that were admitted to the ICU of Fatmawati Hospital Jakarta Indonesia during January 2009 to March 2010. All bacteria were identified by standard microbiologic methods, and their antibiotic susceptibility testing was performed using disk diffusion method. Results: Specimens were collected from 385 patients who were given antimicrobial treatment, of which 249 (64.68%) were cultured positive and 136 (35.32%) were negative. The most predominant isolate was Pseudomonas aeruginosa (P. aeruginosa) (26.5%) followed by Klebsiella pneumoniae (K. pneumoniae) (15.3%) and Staphylococcus epidermidis (14.9%). P. aeruginosa isolates showed high rate of resistance to cephalexin (95.3%), cefotaxime (64.1%), and ceftriaxone (60.9%). Amikacin was the most effective (84.4%) antibiotic against P. aeruginosa followed by imipenem (81.2%), and meropenem (75.0%). K. pneumoniae showed resistance to cephalexin (86.5%), ceftriaxone (75.7%), ceftazidime (73.0%), cefpirome (73.0%) and cefotaxime (67.9%), respectively. Conclusions: Most bacteria isolated from ICU of Fatmawati Hospital Jakarta Indonesia were resistant to the third generation of cephalosporins, and quinolone antibiotics. Regular surveillance of antibiotic susceptibility patterns is very important for setting orders to guide the clinician in choosing empirical or directed therapy of infected patients.

  13. Learning to Promote Health at an Emergency Care Department: Identifying Expansive and Restrictive Conditions (United States)

    Gustavsson, Maria; Ekberg, Kerstin


    This article reports on the findings of a planned workplace health promotion intervention, and the aim is to identify conditions that facilitated or restricted the learning to promote health at an emergency care department in a Swedish hospital. The study had a longitudinal design, with interviews before and after the intervention and follow-up…

  14. Improving the care of people with long-term conditions in primary care: protocol for the ENHANCE pilot trial

    Directory of Open Access Journals (Sweden)

    Emma L. Healey


    Full Text Available Background: Long-term conditions (LTCs are important determinants of quality of life and healthcare expenditure worldwide. Whilst multimorbidity is increasingly the norm in primary care, clinical guidelines and the delivery of care remain focused on single diseases, resulting in poorer clinical outcomes. Osteoarthritis, and anxiety and/or depression frequently co-occur with other LTCs, yet are seldom prioritized by the patient or clinician, resulting in higher levels of disability, poorer prognosis, and increased healthcare costs. Objective: To examine the feasibility and acceptability of an integrated approach to LTC management, tackling the under-diagnosis and under-management of osteoarthritis-related pain and anxiety and/or depression in older adults with other LTCs in primary care. Design: The ENHANCE study is a pilot stepped-wedge cluster randomized controlled trial to test the feasibility and acceptability of a nurse-led ENHANCE LTC review consultation for identifying, assessing, and managing joint pain, and anxiety and/or depression in patients attending LTC reviews. Specific objectives (process evaluation and research outcomes will be achieved through a theoretically informed mixed-methods approach using participant self-reported questionnaires, a medical record review, an ENHANCE EMIS template, qualitative interviews, and audio recordings of the ENHANCE LTC review. Discussion: Success of the pilot trial will be measured against the level of the primary care team engagement, assessment of training delivery, and degree of patient recruitment and retention. Patient satisfaction and treatment fidelity will also be explored. ISRCTN registry number: 12154418. Journal of Comorbidity 2015;5(1:135–149

  15. Informal caregivers of clients with neurological conditions: profiles, patterns and risk factors for distress from a home care prevalence study


    Mitchell, Lori A.; Hirdes, John; Poss, Jeff W.; Slegers-Boyd, Caroline; Caldarelli, Hilary; Martin, Lynn


    Background Individuals living in the community with neurological conditions receive the majority of their care from informal caregivers. The purpose of this project was to provide a profile of caregivers of home care clients with neurological conditions. The study also examined prevalence of caregiver distress and the association between neurological conditions and other client and caregiver characteristics with distress. Methods The study population included Canadian home care clients in the...

  16. Interactive effect of negative affectivity and anxiety sensitivity in terms of mental health among Latinos in primary care. (United States)

    Zvolensky, Michael J; Paulus, Daniel J; Bakhshaie, Jafar; Garza, Monica; Ochoa-Perez, Melissa; Medvedeva, Angela; Bogiaizian, Daniel; Robles, Zuzuky; Manning, Kara; Schmidt, Norman B


    From a public health perspective, primary care medical settings represent a strategic location to address mental health disapirty among Latinos. Yet, there is little empirical work that addresses affective vulnerability processes for mental health problems in such settings. To help address this gap in knowledge, the present investigation examined an interactive model of negative affectivity (tendency to experience negative mood states) and anxiety sensitivity (fear of the negative consequences of aversive sensations) among a Latino sample in primary care in terms of a relatively wide range of anxiety/depression indices. Participants included 390 Latino adults (Mage=38.7, SD=11.3; 86.9% female; 95.6% reported Spanish as first language) from a primary care health clinic. Primary dependent measures included depressive, suicidal, social anxiety, and anxious arousal symptoms, number of mood and anxiety disorders, and disability. Consistent with prediction, the interaction between negative affectivity and anxiety sensitivity was significantly related to suicidal, social anxiety, and anxious arousal symptoms, as well as number of mood/anxiety diagnoses and disability among the primary care Latino sample. The form of the interactions indicated a synergistic effect, such that the greatest levels of each outcome were found among those with high negative affectivity and high anxiety sensitivity. There was a trending interaction for depressive symptoms. Overall, these data provide novel empirical evidence suggesting that there is a clinically-relevant interplay between anxiety sensitivity and negative affectivity in regard to the expression of anxiety and depressive symptoms among a Latino primary care sample.

  17. Using operant conditioning and desensitization to facilitate veterinary care with captive reptiles. (United States)

    Hellmuth, Heidi; Augustine, Lauren; Watkins, Barbara; Hope, Katharine


    In addition to being a large component of most zoological collections, reptile species are becoming more popular as family pets. Reptiles have the cognitive ability to be trained to facilitate daily husbandry and veterinary care. Desensitization and operant conditioning can alleviate some of the behavioral and physiological challenges of treating these species. A survey of reptile training programs at zoos in the United States and worldwide reveals that there are many successful training programs to facilitate veterinary care and minimize stress to the animal. Many of the techniques being used to train reptiles in zoological settings are transferable to the exotic pet clinician.

  18. Integrating care for people with mental illness: the Care Programme Approach in England and its implications for long-term conditions management

    Directory of Open Access Journals (Sweden)

    Nick Goodwin


    Full Text Available Introduction: This policy paper considers what the long-term conditions policies in England and other countries could learn from the experience of the Care Programme Approach (CPA. The CPA was introduced in England in April 1991 as the statutory framework for people requiring support in the community for more severe and enduring mental health problems. The CPA approach is an example of a long-standing 'care co-ordination' model that seeks to develop individualised care plans and then attempt to integrate care for patients from a range of providers.Policy description: The CPA experience is highly relevant to both the English and international debates on the future of long-term conditions management where the agenda has focused on developing co-ordinated care planning and delivery between health and social care; to prioritise upstream interventions that promote health and wellbeing; and to provide for a more personalised service.Conclusion: This review of the CPA experience suggests that there is the potential for better care integration for those patients with multiple or complex needs where a strategy of personalised care planning and pro-active care co-ordination is provided. However, such models will not reach their full potential unless a number of preconditions are met including: clear eligibility criteria; standardised measures of service quality; a mix of governance and incentives to hold providers accountable for such quality; and genuine patient involvement in their own care plans.Implications: Investment and professional support to the role of the care co-ordinator is particularly crucial. Care co-ordinators require the requisite skills and competencies to act as a  care professional  to the patient as well as to have the power to exert authority among other care professionals to ensure multidisciplinary care plans are implemented successfully. Attention to inter-professional practice, culture, leadership and organisational

  19. Complexity in caring for an ageing heart failure population: concomitant chronic conditions and age related impairments. (United States)

    De Geest, Sabina; Steeman, Els; Leventhal, Marcia E; Mahrer-Imhof, Romy; Hengartner-Kopp, Beatrice; Conca, Antoinette; Bernasconi, Arlette T; Petry, Heidi; Brunner-La Rocca, Hanspeter


    The complexity of caring for the ageing heart failure (HF) population is further complicated by concomitant chronic conditions (i.e., polypharmacy, depression), age related impairments (i.e., hearing, visual and cognitive impairments, impairments in activities of daily living (ADL/IADL), and other issues (e.g., health illiteracy, lack of social support). This paper provides an overview of these risk factors, outlines how they individually and in interplay endanger favourable outcome by putting patients at risk for poor self-management. Moreover, suggestions are made on how these issues could be addressed and integrated in heart failure management by applying gerontological care principles in caring for the ageing heart failure population.

  20. Antibiotic sensitivity pattern of bacterial pathogens in the intensive care unit of Fatmawati Hospital,Indonesia

    Institute of Scientific and Technical Information of China (English)

    Maksum; Radji; Siti; Fauziah; Nurgani; Aribinuko


    Objective:To evaluate the sensitivity pattern of bacterial pathogens in the intensive care unit(ICU) of a tertiary care of Falmawati Hospital Jakarta Indonesia.Methods:A cross sectional retrospective study of bacterial pathogen was carried out on a total of 722 patients that were admitted to the ICU of Fatmawati Hospital Jakarta Indonesia during January 2009 to March 2010. All bacteria were identified by standard microbiologic methods,and(heir antibiotic susceptibility testing was performed using disk diffusion method.Results:Specimens were collected from 385 patients who were given antimicrobial treatment,of which 249(64.68%) were cultured positive and 136(35.32%) were negative.The most predominant isolate was Pseudomonas aeruginosa(P.aeruginosa)(26.5%) followed by Klebsiella pneumoniae(K.pneumoniae)(15.3%) and Staphylococcus epidermidis(14.9%).P.aeruginosa isolates showed high rate of resistance to cephalexin(95.3%),cefotaxime(64.1%),and ceftriaxone(60.9%).Amikacin was the most effective(84.4%) antibiotic against P.aeruginosa followed by imipenem(81.2%),and meropenem(75.0%).K.pneumoniae showed resistance to cephalexin(86.5%),ceftriaxone(75.7%),ceftazidime(73.0%),cefpirome(73.0%) and cefotaxime(67.9%),respectively.Conclusions:Most bacteria isolated from ICU of Fatmawati Hospital Jakarta Indonesia were resistant to the third generation of cephalosporins,and quinolone antibiotics.Regular surveillance of antibiotic susceptibility pallerns is very important for setting orders to guide the clinician in choosing empirical or directed therapy of infected patients.

  1. Sensitization to the conditioned rewarding effects of morphine modulates gene expression in rat hippocampus. (United States)

    Marie-Claire, Cynthia; Courtin, Cindie; Robert, Amelie; Gidrol, Xavier; Roques, Bernard P; Noble, Florence


    Opiates addiction is characterized by its long-term persistence. In order to study the enduring changes in long-term memory in hippocampus, a pivotal region for this process, we used suppression subtractive hybridization to compare hippocampal gene expression in morphine and saline-treated rats. Animals were subjected to an extended place preference paradigm consisting of four conditioning phases. Sensitization to the reinforcing effects of the drug occurred after three conditioning phases. After 25 days of treatment rats were euthanized and the complementary DNA (cDNA) from the hippocampus of morphine-dependent and saline-treated animals were then screened for differentially expressed cDNAs. The selected 177 clones were then subjected to a microarray procedure and 20 clones were found differentially regulated. The pattern of regulated genes suggests impairments in neurotransmitter release and the activation of neuroprotective pathways.

  2. Conditioned pain modulation and pressure pain sensitivity in the adult Danish general population

    DEFF Research Database (Denmark)

    Skovbjerg, S.; Jørgensen, Torben; Arendt-Nielsen, Lars;


    Increased pressure pain sensitivity and impaired descending pain control have been associated with chronic pain, but knowledge on the variability in the adult general population is lacking. Pressure pain thresholds (PPTs) and descending pain control as assessed by conditioning pain modulation (CPM......) were recorded in a randomly selected sample (n=2199, 53% females) of the Danish adult general population aged 18-70 years. PPTs were recorded over the tibialis anterior muscle and the upper trapezius muscle. CPM was defined as the difference between PPT assessments before and during conditioning...... associated with lower PPTs (PCPM potency was lower in females compared with males (P≤0.003) whereas no association with age was found. Higher education (P≤0.05), premature withdrawal from the cold pressor test (P≤0.02) and high VAS...

  3. [Non-celiac gluten sensitivity: Another condition that responds to gluten]. (United States)

    Navarro, Elizabeth; Araya, Magdalena


    Remission of gastrointestinal and general symptoms after gluten withdrawal has been described in some non-celiac individuals for nearly 30 years. Only recently, efforts have been made to define this entity, now referred to as "non-celiac gluten sensitivity". It includes patients that clinically respond to gluten free diet without exhibiting allergic or autoimmune features to explain such response. Wheat allergy, celiac disease, irritable bowel syndrome and symptoms induced by high FODMAPs (Fermentable, Oligo-, Di-, Mono-saccharides And Polyols) consumption are the main differential diagnoses. The relationship with neuropsychiatric disorders such as schizophrenia and autism has not been demonstrated, but currently it gives ground to great hope in families with affected children. Epidemiology of non-celiac gluten sensitivity is not clear. It is described as more common among women and less common in children. Genetic and immune factors, changes in intestinal microbiota and non-gluten components present in wheat grains are main factors postulated in the pathogenesis of this condition. To date, there are no specific biomarkers for non-celiac gluten sensitivity and diagnosis is reached by excluding other causes of disease. A trial with gluten-free diet and subsequent gluten challenge is the methodology most frequently used to confirm diagnosis.

  4. Paternal care decreases foraging activity and body condition, but does not impose survival costs to caring males in a Neotropical arachnid.

    Directory of Open Access Journals (Sweden)

    Gustavo S Requena

    Full Text Available Exclusive paternal care is the rarest form of parental investment in nature and theory predicts that the maintenance of this behavior depends on the balance between costs and benefits to males. Our goal was to assess costs of paternal care in the harvestman Iporangaia pustulosa, for which the benefits of this behavior in terms of egg survival have already been demonstrated. We evaluated energetic costs and mortality risks associated to paternal egg-guarding in the field. We quantified foraging activity of males and estimated how their body condition is influenced by the duration of the caring period. Additionally, we conducted a one-year capture-mark-recapture study and estimated apparent survival probabilities of caring and non-caring males to assess potential survival costs of paternal care. Our results indicate that caring males forage less frequently than non-caring individuals (males and females and that their body condition deteriorates over the course of the caring period. Thus, males willing to guard eggs may provide to females a fitness-enhancing gift of cost-free care of their offspring. Caring males, however, did not show lower survival probabilities when compared to both non-caring males and females. Reduction in mortality risks as a result of remaining stationary, combined with the benefits of improving egg survival, may have played an important and previously unsuspected role favoring the evolution of paternal care. Moreover, males exhibiting paternal care could also provide an honest signal of their quality as offspring defenders, and thus female preference for caring males could be responsible for maintaining the trait.

  5. Mephedrone ('bath salt') elicits conditioned place preference and dopamine-sensitive motor activation. (United States)

    Lisek, Renata; Xu, Wei; Yuvasheva, Ekaterina; Chiu, Yi-Ting; Reitz, Allen B; Liu-Chen, Lee-Yuan; Rawls, Scott M


    Abuse of a dangerous street drug called mephedrone (4-methylmethcathinone) has become commonplace in the United States. Mephedrone is hypothesized to possess abuse liability, share pharmacological properties with psychostimulants, and display toxicity that has been linked to fatalities and non-fatal overdoses. Knowledge about the pharmacology of mephedrone has been obtained primarily from surveys of drug abusers and emergency room visits rather than experimental studies. The present study used motor activity and conditioned place preference (CPP) assays to investigate behavioral effects of mephedrone. Acute mephedrone (3, 5, 10, 30 mg/kg, ip) administration increased ambulatory activity in rats. Mephedrone (5 mg/kg, ip)-induced ambulation was inhibited by pretreatment with a dopamine D1 receptor antagonist (SCH 23390) (0.5, 1, 2 mg/kg, ip) and enhanced by pretreatment with a dopamine D2 receptor antagonist (sulpiride) (2 mg/kg, ip). Rats injected for 5 days with low dose mephedrone (0.5 mg/kg, ip) and then challenged with mephedrone (0.5 mg/kg, ip) following 10 days of abstinence displayed sensitization of ambulatory activity. In CPP experiments, mephedrone (30 mg/kg, ip) conditioning elicited a preference shift in both rats and mice. The CPP and dopamine-sensitive motor activation produced by mephedrone is suggestive of abuse liability and indicates commonalities between the neuropharmacological profiles of mephedrone and established drugs of abuse.

  6. Applications of Conditional Nonlinear Optimal Perturbation in Predictability Study and Sensitivity Analysis of Weather and Climate

    Institute of Scientific and Technical Information of China (English)


    Considering the limitation of the linear theory of singular vector (SV), the authors and their collaborators proposed conditional nonlinear optimal perturbation (CNOP) and then applied it in the predictability study and the sensitivity analysis of weather and climate system. To celebrate the 20th anniversary of Chinese National Committee for World Climate Research Programme (WCRP), this paper is devoted to reviewing the main results of these studies. First, CNOP represents the initial perturbation that has largest nonlinear evolution at prediction time, which is different from linear singular vector (LSV) for the large magnitude of initial perturbation or/and the long optimization time interval. Second, CNOP,rather than linear singular vector (LSV), represents the initial anomaly that evolves into ENSO events most probably. It is also the CNOP that induces the most prominent seasonal variation of error growth for ENSO predictability; furthermore, CNOP was applied to investigate the decadal variability of ENSO asymmetry. It is demonstrated that the changing nonlinearity causes the change of ENSO asymmetry.Third, in the studies of the sensitivity and stability of ocean's thermohaline circulation (THC), the non-linear asymmetric response of THC to finite amplitude of initial perturbations was revealed by CNOP.Through this approach the passive mechanism of decadal variation of THC was demonstrated; Also the authors studies the instability and sensitivity analysis of grassland ecosystem by using CNOP and show the mechanism of the transitions between the grassland and desert states. Finally, a detailed discussion on the results obtained by CNOP suggests the applicability of CNOP in predictability studies and sensitivity analysis.

  7. Condition of cleanliness of surfaces close to patients in an intensive care unit


    Ferreira,Adriano Menis; Andrade,Denise de; Rigotti, Marcelo Alessandro; Ferreira, Maria Verônica Ferrareze


    ABSTRACT - Surface cleaning is a well-known control procedure against the dissemination of microorganisms in the hospital environment. This prospective study, carried out in an intensive care unit over the course of 14 days, describes the cleaning/disinfection conditions of four surfaces near patients. In total, 100 assessments of the surfaces were carried out after they were cleaned. Three methods were used to evaluate cleanliness: a visual inspection, an adenosine triphosphate (ATP) biolumi...

  8. The combination of health anxiety and somatic symptoms: Specificity to anxiety sensitivity cognitive concerns among patients in primary care. (United States)

    Fergus, Thomas A; Kelley, Lance P; Griggs, Jackson O


    Prior research has found that health anxiety is related to poor patient outcomes in primary care settings. Health anxiety is characterized by at least two presentations: with either severe or no/mild somatic symptoms. Preliminary data indicate that anxiety sensitivity may be important for understanding the presentation of health anxiety with severe somatic symptoms. We further examined whether the combination of health anxiety and somatic symptoms was related to anxiety sensitivity. Participants were adults presenting for treatment at a community health center (N=538). As predicted, the interactive effect between health anxiety and somatic symptoms was associated with anxiety sensitivity cognitive concerns. Health anxiety shared a stronger association with anxiety sensitivity cognitive concerns when coupled with severe, relative to mild, somatic symptoms. Contrary to predictions, the interactive effect was not associated with the other dimensions of anxiety sensitivity. We discuss the potential relevancy of anxiety sensitivity cognitive concerns to the combined presentation of health anxiety and severe somatic symptoms, as well as how this dimension of anxiety sensitivity could be treated in primary care settings.

  9. Runoff sensitivity over Asia: Role of climate variables and initial soil conditions (United States)

    Liu, Di; Mishra, Ashok K.; Zhang, Ke


    We applied statistical and numerical modeling approach to evaluate the sensitivity of runoff (ROF) to climate variables using Global Land Data Assimilation System (GLDAS) data and regional climate model (RegCM4). It was observed that ROF is more sensitive to precipitation (P) compared to other analyzed hydroclimatic variables (potential evapotranspiration (PET), 2 m air temperature (T2m), solar radiation (Rn), specific humidity (SSH), and wind speed (U), especially over India, Indochina, and south-north-northeast China semihumid-humid climate transition zones based on the higher correlation coefficient (>0.7) and elasticity (>2). The abnormal positive T2m-ROF observed over Tibetan Plateau region (TP) may be due to its high topography and cold weather regime, while positive PET-ROF over India and north China-southeast Mongolia regions can be attributed to the stronger influence of local land-atmosphere interactions. Soil moisture (SM) reflects high correlation with runoff, especially over the climate transition zones (i.e., India and Indochina-southeast China). The initial wet (dry) soil moisture (SM) anomalies lead to an increase (decrease) of ROF in each season with the hot spots mainly located in middle to high latitudes (spring), TP and northeast (summer and autumn), and Indochina (autumn) regions. Such influence can persist almost 4 months in spring while only about 1 month in autumn during dry and wet conditions. The wet condition has stronger influence at beginning but dissipates quickly, while the dry condition can last longer within the same season. The impact of initial soil temperature anomalies on ROF is weaker than SM, with the only obvious ROF changes located over south China (spring and summer) and north India (autumn).

  10. Sensitivity to Speaker Control in the Online Comprehension of Conditional Tips and Promises: An Eye-Tracking Study (United States)

    Stewart, Andrew J.; Haigh, Matthew; Ferguson, Heather J.


    Statements of the form if… then… can be used to communicate conditional speech acts such as tips and promises. Conditional promises require the speaker to have perceived control over the outcome event, whereas conditional tips do not. In an eye-tracking study, we examined whether readers are sensitive to information about perceived speaker control…

  11. Educators' working conditions in a day care centre on ownership of a non-profit organization

    Directory of Open Access Journals (Sweden)

    Kusma Bianca


    Full Text Available Abstract Background Working conditions of nursery school teachers have not been scrutinized thoroughly in scientific research. Only a few studies have so far examined work-load and strain in this profession. Preferably, subjective perceptions should be corroborated by data that can be quantified more objectively and accurately. The aim of the present observational field study was to evaluate pedagogical staffs' workflow. Methods In 2009 eleven educators in a day care centre were observed throughout three complete workdays. A total of 250 working hours were recorded. Results An educators' workday lasted on average 07:46:59 h (SD = 01:01:10 h. Within this time span, an average of 02:20:46 h (30.14%, SD = 00:28:07 h were spent on caring, 01:44:18 h on playing (22.33%, SD = 00:54:12 h, 00:49:37 h on educational work (10.62%, SD = 00:40:09, and only 00:05:38 h on individual child contact (1.21%, SD = 00:04:58 h. Conclusion For the first time, educators' workflow in day care centres was studied in real time. Some of the educators' self-reported problems were corroborated. The results of this study form a basis upon which further investigations can be built and measures can be developed for an overall improvement of child care.

  12. Anxiety sensitivity and its impact on pain experiences and conditions: a state of the art. (United States)

    Stewart, Sherry H; Asmundson, Gordon J G


    This paper serves as an introduction to the special issue of Cognitive Behaviour Therapy devoted to the topic of anxiety sensitivity (AS) and its impact on pain experiences and conditions. We provide a historical overview of relevant cognitive behavioural models of chronic pain, summarize recent models incorporating the AS construct, and introduce the papers in the special issue. These papers are organized into two sets--basic laboratory-based investigations and relatively more applied studies. We attempt to highlight some of the most important findings from each of these investigations and studies, in turn. Then, we consider several important conclusions derived from the set of special issue papers and the implications of these for the practice of cognitive-behavioural interventions with pain populations. Finally, we make several suggestions for directions for future investigations in this burgeoning area of cognitive behavioural research and practice.

  13. The Health and Working Conditions of Women Employed in Child Care. (United States)

    Linnan, Laura; Arandia, Gabriela; Bateman, Lori A; Vaughn, Amber; Smith, Natalie; Ward, Dianne


    Over one million women are employed in child care and are among the lowest wage workers in the US. The health and working conditions of 674 child care workers (118 administrators and 556 staff) from 74 centers is described using baseline data from a larger intervention trial. Participants were 39.9 (±13.0) years old; 55.4% African American, 37.1% Caucasian, and 5.3% of Hispanic ethnicity. Seventy-six percent reported having an Associate's degree or less; 42% were classified as at or below poverty (income and job category. Lower income participants were significantly more likely to be current smokers (19.9% vs. 11.7%), drink more sweetened beverages (1.9 vs. 1.5), and report higher depressive symptoms (15.5 vs. 12.6). Administrators worked more hours weekly compared to staff (46.4 vs. 40.6), are less active (100 vs. 126 min/week), more sedentary (501 vs. 477 min/day), and reported higher job demands (13.3 vs. 12.5). Given the numerous health issues and challenging work conditions, we hope our results serve as a call to action for addressing low wages and the work environment as a means of influencing the health and well-being of child care workers.

  14. The Health and Working Conditions of Women Employed in Child Care

    Directory of Open Access Journals (Sweden)

    Laura Linnan


    Full Text Available Over one million women are employed in child care and are among the lowest wage workers in the US. The health and working conditions of 674 child care workers (118 administrators and 556 staff from 74 centers is described using baseline data from a larger intervention trial. Participants were 39.9 (±13.0 years old; 55.4% African American, 37.1% Caucasian, and 5.3% of Hispanic ethnicity. Seventy-six percent reported having an Associate’s degree or less; 42% were classified as at or below poverty (<$20,000; and exhibited many health risks such as excess weight, insufficient activity, poor diet, and inadequate sleep. We investigated potential differences by income and job category. Lower income participants were significantly more likely to be current smokers (19.9% vs. 11.7%, drink more sweetened beverages (1.9 vs. 1.5, and report higher depressive symptoms (15.5 vs. 12.6. Administrators worked more hours weekly compared to staff (46.4 vs. 40.6, are less active (100 vs. 126 min/week, more sedentary (501 vs. 477 min/day, and reported higher job demands (13.3 vs. 12.5. Given the numerous health issues and challenging work conditions, we hope our results serve as a call to action for addressing low wages and the work environment as a means of influencing the health and well-being of child care workers.

  15. Mutant DISC1 affects methamphetamine-induced sensitization and conditioned place preference: a comorbidity model. (United States)

    Pogorelov, Vladimir M; Nomura, Jun; Kim, Jongho; Kannan, Geetha; Ayhan, Yavuz; Yang, Chunxia; Taniguchi, Yu; Abazyan, Bagrat; Valentine, Heather; Krasnova, Irina N; Kamiya, Atsushi; Cadet, Jean Lud; Wong, Dean F; Pletnikov, Mikhail V


    Genetic factors involved in neuroplasticity have been implicated in major psychiatric illnesses such as schizophrenia, depression, and substance abuse. Given its extended interactome, variants in the Disrupted-In-Schizophrenia-1 (DISC1) gene could contribute to drug addiction and psychiatric diseases. Thus, we evaluated how dominant-negative mutant DISC1 influenced the neurobehavioral and molecular effects of methamphetamine (METH). Control and mutant DISC1 mice were studied before or after treatment with non-toxic escalating dose (ED) of METH. In naïve mice, we assessed METH-induced conditioned place preference (CPP), dopamine (DA) D2 receptor density and the basal and METH-induced activity of DISC1 partners, AKT and GSK-3β in the ventral striatum. In ED-treated mice, 4 weeks after METH treatment, we evaluated fear conditioning, depression-like responses in forced swim test, and the basal and METH-induced activity of AKT and GSK-3β in the ventral striatum. We found impairment in METH-induced CPP, decreased DA D2 receptor density and altered METH-induced phosphorylation of AKT and GSK-3β in naïve DISC1 female mice. The ED regimen was not neurotoxic as evidenced by unaltered brain regional monoamine tissue content. Mutant DISC1 significantly delayed METH ED-produced sensitization and affected drug-induced phosphorylation of AKT and GSK-3β in female mice. Our results suggest that perturbations in DISC1 functions in the ventral striatum may impact the molecular mechanisms of reward and sensitization, contributing to comorbidity between drug abuse and major mental diseases.

  16. A highly sensitive and simply operated protease sensor toward point-of-care testing. (United States)

    Park, Seonhwa; Shin, Yu Mi; Seo, Jeongwook; Song, Ji-Joon; Yang, Haesik


    Protease sensors for point-of-care testing (POCT) require simple operation, a detection period of less than 20 minutes, and a detection limit of less than 1 ng mL(-1). However, it is difficult to meet these requirements with protease sensors that are based on proteolytic cleavage. This paper reports a highly reproducible protease sensor that allows the sensitive and simple electrochemical detection of the botulinum neurotoxin type E light chain (BoNT/E-LC), which is obtained using (i) low nonspecific adsorption, (ii) high signal-to-background ratio, and (iii) one-step solution treatment. The BoNT/E-LC detection is based on two-step proteolytic cleavage using BoNT/E-LC (endopeptidase) and l-leucine-aminopeptidase (LAP, exopeptidase). Indium-tin oxide (ITO) electrodes are modified partially with reduced graphene oxide (rGO) to increase their electrocatalytic activities. Avidin is then adsorbed on the electrodes to minimize the nonspecific adsorption of proteases. Low nonspecific adsorption allows a highly reproducible sensor response. Electrochemical-chemical (EC) redox cycling involving p-aminophenol (AP) and dithiothreitol (DTT) is performed to obtain a high signal-to-background ratio. After adding a C-terminally AP-labeled oligopeptide, DTT, and LAP simultaneously to a sample solution, no further treatment of the solution is necessary during detection. The detection limits of BoNT/E-LC in phosphate-buffered saline are 0.1 ng mL(-1) for an incubation period of 15 min and 5 fg mL(-1) for an incubation period of 4 h. The detection limit in commercial bottled water is 1 ng mL(-1) for an incubation period of 15 min. The developed sensor is selective to BoNT/E-LC among the four types of BoNTs tested. These results indicate that the protease sensor meets the requirements for POCT.

  17. Hydrolysed ginseng-saponin quaternary: a novel conditioning agent for hair care products. (United States)

    Young-Dae, K; Chang-Kew, K; Chung-Nam, L; Byung-Jo, H


    Synopsis A new quaternary ammonium compound, hydrolysed ginseng-saponin quaternary (HGSQ), from Korean ginseng saponin and 2,3-epoxypropyltrimethyl ammonium chloride, has been developed as a conditioning agent for hair care products. This structure has a hydrophobic group from the aglycone of ginseng saponin which is biologically active and considered as the most important component of Korean ginseng. Its properties of surface tension, conductivity, critical micelle concentration (CMC), eye irritation, sorption onto hair, tensile strength for 20% extension and moisture retention effect were studied. Its cationic character allows the molecule to be more substantive than ginseng saponin. HGSQ had good physical properties and was safe enough as a cosmetic raw material. Also half-head tests of HGSQ-containing shampoo were carried out to evaluate the conditioning effects in shampoos. HGSQ showed good conditioning properties in a shampoo.

  18. Sensitivity analyses of a colloid-facilitated contaminant transport model for unsaturated heterogeneous soil conditions. (United States)

    Périard, Yann; José Gumiere, Silvio; Rousseau, Alain N.; Caron, Jean


    effects and the one-at-a-time approach (O.A.T); and (ii), we applied Sobol's global sensitivity analysis method which is based on variance decompositions. Results illustrate that ψm (maximum sorption rate of mobile colloids), kdmc (solute desorption rate from mobile colloids), and Ks (saturated hydraulic conductivity) are the most sensitive parameters with respect to the contaminant travel time. The analyses indicate that this new module is able to simulate the colloid-facilitated contaminant transport. However, validations under laboratory conditions are needed to confirm the occurrence of the colloid transport phenomenon and to understand model prediction under non-saturated soil conditions. Future work will involve monitoring of the colloidal transport phenomenon through soil column experiments. The anticipated outcome will provide valuable information on the understanding of the dominant mechanisms responsible for colloidal transports, colloid-facilitated contaminant transport and, also, the colloid detachment/deposition processes impacts on soil hydraulic properties. References: Šimůnek, J., C. He, L. Pang, & S. A. Bradford, Colloid-Facilitated Solute Transport in Variably Saturated Porous Media: Numerical Model and Experimental Verification, Vadose Zone Journal, 2006, 5, 1035-1047 Šimůnek, J., M. Šejna, & M. Th. van Genuchten, The C-Ride Module for HYDRUS (2D/3D) Simulating Two-Dimensional Colloid-Facilitated Solute Transport in Variably-Saturated Porous Media, Version 1.0, PC Progress, Prague, Czech Republic, 45 pp., 2012.

  19. Sensitivity of Pliocene climate simulations in MRI-CGCM2.3 to respective boundary conditions (United States)

    Kamae, Youichi; Yoshida, Kohei; Ueda, Hiroaki


    Accumulations of global proxy data are essential steps for improving reliability of climate model simulations for the Pliocene warming climate. In the Pliocene Model Intercomparison Project phase 2 (PlioMIP2), a part project of the Paleoclimate Modelling Intercomparison Project phase 4, boundary forcing data have been updated from the PlioMIP phase 1 due to recent advances in understanding of oceanic, terrestrial and cryospheric aspects of the Pliocene palaeoenvironment. In this study, sensitivities of Pliocene climate simulations to the newly archived boundary conditions are evaluated by a set of simulations using an atmosphere-ocean coupled general circulation model, MRI-CGCM2.3. The simulated Pliocene climate is warmer than pre-industrial conditions for 2.4 °C in global mean, corresponding to 0.6 °C warmer than the PlioMIP1 simulation by the identical climate model. Revised orography, lakes, and shrunk ice sheets compared with the PlioMIP1 lead to local and remote influences including snow and sea ice albedo feedback, and poleward heat transport due to the atmosphere and ocean that result in additional warming over middle and high latitudes. The amplified higher-latitude warming is supported qualitatively by the proxy evidences, but is still underestimated quantitatively. Physical processes responsible for the global and regional climate changes should be further addressed in future studies under systematic intermodel and data-model comparison frameworks.

  20. Texture-defined objects influence responses of blowfly motion-sensitive neurons under natural dynamical conditions

    Directory of Open Access Journals (Sweden)

    Thomas W. Ullrich


    Full Text Available The responses of visual interneurons of flies involved in the processing of motion information do not only depend on the velocity, but also on other stimulus parameters, such as the contrast and the spatial frequency content of the stimulus pattern. These dependencies have been known for long, but it is still an open question how they affect the neurons’ performance in extracting information about the structure of the environment under the specific dynamical conditions of natural flight. Free-flight of blowflies is characterized by sequences of phases of translational movements lasting for just 30-100 milliseconds interspersed with even shorter and extremely rapid saccade-like rotational shifts in flight and gaze direction. Previous studies already analyzed how nearby objects, leading to relative motion on the retina with respect to a more distant background, influenced the response of a class of fly motion sensitive visual interneurons, the HS cells. In the present study, we focused on objects that differed from their background by discontinuities either in their brightness contrast or in their spatial frequency content. We found strong object-induced effects on the membrane potential even during the short intersaccadic intervals, if the background contrast was small and the object contrast sufficiently high. The object evoked similar response increments provided that it contained higher spatial frequencies than the background, but not under reversed conditions. This asymmetry in the response behavior is partly a consequence of the depolarization level induced by the background. Thus, our results suggest that, under the specific dynamical conditions of natural flight, i.e. on a very short timescale, the responses of HS cells represent object information depending on the polarity of the difference between object and background contrast and spatial frequency content.

  1. Depression and risk of hospitalisations and rehospitalisations for ambulatory care-sensitive conditions in Denmark

    DEFF Research Database (Denmark)

    Davydow, Dimitry S; Fenger-Grøn, Morten; Ribe, Anette Riisgaard;


    , at risikoen for indlæggelse var 2,35 gange højere hos danskere med depression. Forskerne har set på de såkaldte preventable hospitalizations – altså indlæggelser, som måske kunne være undgået, hvis forebyggelse og behandling havde fungeret optimalt, herunder at patienten havde fulgt lægens anvisninger......Dette studie viser, at danskere med depression oftere end andre bliver hospitalsindlagt for kroniske sygdomme, som måske godt kunne være behandlet i det nære sundhedsvæsen uden indlæggelse. Den samme gruppe har også en højere risiko for at blive genindlagt inden for 30 dage. Resultaterne viser...

  2. Targeting Medicare consumers. Managed care providers can make inroads by understanding preference and cost-sensitivity issues. (United States)

    Stensrud, J; Sylvestre, E; Sivadas, E


    The authors' conjoint study provided valuable information on the preferences of the hugh Medicare-eligible and soon-to-be-eligible markets. Leading the list were hospitalization coverage, skilled nursing facilities, and out-of-area coverage. The task of defining choice sets was made easier and more meaningful by selecting the top six attributes for each respondent. Asking respondents to rank levels within each attribute and assessing the importance of the various levels provided a more robust estimate of consumer preferences. Using an innovative price-sensitivity method preserved the integrity of the data. The method minimized respondent fatigue and enabled the authors to gather price-sensitivity data from respondents who were not actually paying for their health services. Respondents preferred Supplemental F and Medicare products even though they placed more value on the qualities of alternative health care products. This suggests that managed care providers need to change consumer perceptions about their products.

  3. Antibiotic sensitivity of Enterobacteriaceae at a tertiary care center in India

    Directory of Open Access Journals (Sweden)

    Summaiya Mulla


    Full Text Available Aims and Objectives: It has been observed that various microorganisms are acquiring resistance to most of the available potent antibiotics; hence, there is a need for every hospital to follow the use of antibiotics according to antibiotic sensitivity pattern in that particular hospital or geographical area. It has been reported that Enterobacteriaceae group of microorganisms are increasingly acquiring resistance to many antibiotics and this resistance varies geographically. As there is a short of recent data with respect to Indian hospital, this particular study was designed with the aim of establishing sensitivity pattern of Enterobacteriaceae group of microorganisms to various antibiotics. Materials and Methods: Data of antibiotic sensitivity from December 2010 to April 2011 of different Enterobacteriaceae was taken from the Department of Microbiology, Govt. Medical College, Surat. Sensitivity of different Enterobacteriaceae was shown as using descriptive statistics. Results: E. coli (55.6% and Klebsiella (31.2% were the most frequent bacteria isolated. Enterobacteriaceae were very less sensitive to amoxicillin + clavulanic acid (13.7%, chloramphenicol (7.6%, cefoperazone (14.4%, cefixime (15.7%, and cefuroxime (17.6. Sensitivity to aztreonam was 32.7%. Sensitivity to carbapenem group of drugs included in this study, i.e., meropenem was 69.8%. Highest sensitivity was shown for ceftazidime (74.1%. E. coli is more sensitive to meropenem as compared with Klebsiella. Conclusion: Sensitivity of Enterobacteriaceae group of microorganisms to known antibiotics is decreasing. Decreased sensitivity to carbapenem group of antibiotics is a matter of concern.

  4. Sensitivity of regional ensemble data assimilation spread to perturbations of lateral boundary conditions

    Directory of Open Access Journals (Sweden)

    Rachida El Ouaraini


    Full Text Available The implementation of a regional ensemble data assimilation and forecasting system requires the specification of appropriate perturbations of lateral boundary conditions (LBCs, in order to simulate associated errors. The sensitivity of analysis and 6-h forecast ensemble spread to these perturbations is studied here formally and experimentally by comparing three different LBC configurations for the ensemble data assimilation system of the ALADIN-France limited-area model (LAM. While perturbed initial LBCs are provided by the perturbed LAM analyses in each ensemble, the three ensemble configurations differ with respect to LBCs used at 3- and 6-h forecast ranges, which respectively correspond to: (1 perturbed LBCs provided by the operational global ensemble data assimilation system (GLBC, which is considered as a reference configuration; (2 unperturbed LBCs (ULBC obtained from the global deterministic model; (3 perturbed LBCs obtained by adding random draws of an error covariance model (PLBC to the global deterministic system. A formal analysis of error and perturbation equations is first carried out, in order to provide an insight of the relative effects of observation perturbations and of LBC perturbations at different ranges, in the various ensemble configurations. Horizontal variations of time-averaged ensemble spread are then examined for 6-h forecasts. Despite the use of perturbed initial LBCs, the regional ensemble ULBC is underdispersive not only near the lateral boundaries, but also in approximately one-third of the inner area, due to advection during the data assimilation cycle. This artefact is avoided in PLBC through the additional use of non-zero LBC perturbations at 3- and 6-h ranges, and the sensitivity to the amplitude scaling of the covariance model is illustrated for this configuration. Some aspects of the temporal variation of ensemble spread and associated sensitivities to LBC perturbations are also studied. These results

  5. How Does Sensitivity Training of Health Care Workers Impact Patient Satisfaction? (United States)

    De Vinci, Katrina Marie


    Health care of the 21st century is undergoing major changes due to a myriad of social factors affecting every level of society. From financial desperation due to the high cost of health care to the increased awareness of a generation asking for better services, the importance of patient satisfaction is paramount. The Centers for Medicare and…

  6. Sensitivity of surveillance testing for multidrug-resistant Gram-negative bacteria in the intensive care unit. (United States)

    Ridgway, Jessica P; Peterson, Lance R; Thomson, Richard B; Miller, Becky A; Wright, Marc-Oliver; Schora, Donna M; Robicsek, Ari


    We tested intensive care unit patients for colonization with multidrug-resistant Gram-negative bacilli (MDR GNB) and compared the results with those of concurrent clinical cultures. The sensitivity of the surveillance test for detecting MDR GNB was 58.8% (95% confidence interval, 48.6 to 68.5%). Among 133 patients with positive surveillance tests, 61% had no prior clinical culture with MDR GNB.

  7. Continuity of care for children with complex chronic health conditions: parents' perspectives

    Directory of Open Access Journals (Sweden)

    Shaw Nicola


    Full Text Available Abstract Background Continuity of care has been explored largely from academic and service provider perspectives, and in relation to adult patient/client groups. We interviewed parents of children with complex chronic health conditions to examine how their experiences and perceptions of continuity of care fit with these perspectives; and to identify the salient factors in the experience of, and factors contributing to, continuity in this population. Methods Parents of 47 elementary school-aged children with spina bifida, Down syndrome, attention-deficit/hyperactivity disorder, Duchenne muscular dystrophy or cystic fibrosis participated in semi-structured interviews. Parents described and mapped the pattern of their interactions with service providers over time in all domains relevant to their child's health, well-being, and development (medical, rehabilitational, educational, and social supportive services, with particular attention paid to their perceptions of connectedness or coherency in these interactions. Verbatim transcripts were analyzed thematically using a framework approach to impose structure regarding parents' perspectives on continuity of care. Results Existing academic concepts of relational, informational and management continuity were all discernable in parents' narratives. A thorough knowledge of the child on the part of service providers emerged as extremely important to parents; such knowledge was underpinned by continuity of personal relationships, principally, and also by written information. For this population, notions of continuity extend to the full range of service providers these children and families need to achieve optimal health status, and are not limited to physicians and nurses. Communication among providers was seen as integral to perceived continuity. Compartmentalization of services and information led to parents assuming a necessary, though at times, uncomfortable, coordinating role. Geographic factors

  8. Pre-Existing Condition Insurance Plans created by the Affordable Care Act of 2010. (United States)

    Hall, Jean; Moore, Janice


    The Patient Protection and Affordable Care Act includes a provision for the establishment of a temporary high-risk pool, also called the Pre-Existing Condition Insurance Plan (PCIP), to quickly make health insurance available to uninsured individuals with preexisting conditions, many of whom previously had been denied coverage. Twenty-seven states elected to administer the PCIPs for their citizens, while the remaining states and the District of Columbia chose to let their PCIPs be federally administered. This issue brief examines eligibility, benefits, premiums, cost-sharing, and oversight of the PCIP programs, as well as variation of the plans from state to state. The PCIPs will run through December 31, 2013, at which time participants will be transitioned to exchange coverage.

  9. Influence of Conditions of Heating up on Integral Characteristics of Heattransfer in the Sensitive Element of the Thermoconjugate Sensor

    Directory of Open Access Journals (Sweden)

    Atroshenko Yuliana K.


    Full Text Available Heattransfer models in a sensitive element of the thermoconjugate temperature sensor in different conditions of heating up of the thermocouple are developed. Tasks of heat conduction for cases when on outline borders of the thermocouple conditions of I, II and III kinds are set are considered. Dependences of necessary duration of heating up of the thermocouple for different values of a heat flux to outline borders of a sensitive element for thermocouples of types K, L and E, distribution of temperature in the thermocouple in different conditions of heating up are received.

  10. 42 CFR 484.18 - Condition of participation: Acceptance of patients, plan of care, and medical supervision. (United States)


    ... a doctor of medicine, osteopathy, or podiatric medicine. (a) Standard: Plan of care. The plan of..., plan of care, and medical supervision. 484.18 Section 484.18 Public Health CENTERS FOR MEDICARE... HEALTH SERVICES Administration § 484.18 Condition of participation: Acceptance of patients, plan of...

  11. Associations of Caregiver Stress with Working Conditions, Caregiving Practices, and Child Behaviour in Home-Based Child Care (United States)

    Rusby, Julie C.; Jones, Laura Backen; Crowley, Ryann; Smolkowski, Keith


    Home-based child caregivers face unique stressors related to the nature of their work. One hundred and fifty-five home-based child care providers in Oregon, USA, participated in this cross-sectional correlational study. We investigated associations between indicators of caregiver stress and child care working conditions, the quality of caregiver…

  12. A Study of Child Care Professionals' Salaries, Benefits, and Working Conditions: Lake, Marin, Mendocino, Napa, and Sonoma Counties. (United States)

    Community Child Care Council of Sonoma County, Santa Rosa, CA.

    Surveys were made of the salaries, benefits, and working conditions of child care professionals in Lake, Marin, Mendocino, Napa, and Sonoma Counties. The centers sampled operated under a variety of auspices. Centers included nonprofit (without subsidized child care spaces), proprietary, public, and subsidized organizations. The survey instrument…


    Directory of Open Access Journals (Sweden)

    Soraia Napoleão Freitas


    Full Text Available This paper discusses about management and school inclusion of students with disabilities who are living under institutional care conditions. The themes are relevant given that there is little research that aims to relate them. Therefore, this study aimed to investigate and understand the reality of educational management on the inclusion of students with disabilities living in institutional care conditions. Some authors were selected to support this study, including: Lück (2006; Libâneo, Oliveira and Toschi (2005; Sousa and Paravidini (2013; Carvalho (2006; Tezani (2010; Yin (2010; and Bardin (2011. This research was classified as qualitative case study. The instruments for data collection were semi-structured interviews and observations in the school the disabled student was enrolled in.  The results point to a still deficient inclusive practice, and the school states that the support from the City Department of Education is still incipient in support to the work of school management in the provision of financial and human resources for the inclusion to happen. It can be observed that for inclusion to be effective, it is necessary a truly articulated work among all people involved in the process.

  14. Comparison of steam sterilization conditions efficiency in the treatment of Infectious Health Care Waste. (United States)

    Maamari, Olivia; Mouaffak, Lara; Kamel, Ramza; Brandam, Cedric; Lteif, Roger; Salameh, Dominique


    Many studies show that the treatment of Infectious Health Care Waste (IHCW) in steam sterilization devices at usual operating standards does not allow for proper treatment of Infectious Health Care Waste (IHCW). Including a grinding component before sterilization allows better waste sterilization, but any hard metal object in the waste can damage the shredder. The first objective of the study is to verify that efficient IHCW treatment can occur at standard operating parameters defined by the contact time-temperature couple in steam treatment systems without a pre-mixing/fragmenting or pre-shredding step. The second objective is to establish scientifically whether the standard operation conditions for a steam treatment system including a step of pre-mixing/fragmenting were sufficient to destroy the bacterial spores in IHCW known to be the most difficult to treat. Results show that for efficient sterilization of dialysis cartridges in a pilot 60L steam treatment system, the process would require more than 20 min at 144°C without a pre-mixing/fragmenting step. In a 720L steam treatment system including pre-mixing/fragmenting paddles, only 10 min at 144°C are required to sterilize IHCW proved to be sterilization challenges such as dialysis cartridges and diapers in normal conditions of rolling.

  15. Sensitivity of basal conditions in an inverse model: Vestfonna ice cap, Nordaustlandet/Svalbard

    Directory of Open Access Journals (Sweden)

    M. Schäfer


    Full Text Available The dynamics of Vestfonna ice cap (Svalbard are dominated by fast-flowing outlet glaciers. Its mass balance is poorly known and affected dynamically by these fast-flowing outlet glaciers. Hence, it is a challenging target for ice flow modeling. Precise knowledge of the basal conditions and implementation of a good sliding law are crucial for the modeling of this ice cap. Here we use the full-Stokes finite element code Elmer/Ice to model the 3-D flow over the whole ice cap. We use a Robin inverse method to infer the basal friction from the surface velocities observed in 1995. Our results illustrate the importance of the basal friction parameter in reproducing observed velocity fields. We also show the importance of having variable basal friction as given by the inverse method to reproduce the velocity fields of each outlet glacier – a simple parametrization of basal friction cannot give realistic velocities in a forward model. We study the robustness and sensitivity of this method with respect to different parameters (mesh characteristics, ice temperature, errors in topographic and velocity data. The uncertainty in the observational parameters and input data proved to be sufficiently small as not to adversely affect the fidelity of the model.

  16. Modeled riparian stream shading: Agreement with field measurements and sensitivity to riparian conditions (United States)

    Li, Guoyuan; Jackson, C. Rhett; Kraseski, Kristin A.


    SummaryShading by riparian vegetation and streambanks reduces incident solar radiation on channels, and accurate estimation of riparian shading through the sun's daily arc is a critical aspect of water temperature and dissolved oxygen modeling. However, riparian trees exhibit complex shapes, often leaning and growing branches preferentially over channels to utilize the light resource. As a result, riparian vegetation cast complex shadows with significant variability at the scale of meters. Water quality models necessarily simplify factors affecting shading at the expense of accuracy. All models must make simplifying assumptions about tree geometry. Reach-based models must average channel azimuth and riparian conditions over each reach, and GIS models must also accept errors in the channel-riparian relationships caused by the DEM grid detail. We detail minor improvements to existing shade models and create a model (SHADE2) that calculates shading ratio (%) by riparian canopy at any time and location for given stream characteristics including stream azimuth, stream width, canopy height, canopy overhang, and height of maximum canopy overhang. Sensitivity of simulated shade to these variables is explored. We also present a new field photographic technique for quantifying shade and use this technique to provide data to test the SHADE2 algorithm. Twenty-four independent shade measurements were made in eight channels with mature hardwood riparian trees at different times of the summer and at different times of the day. Agreement between measured and modeled shade was excellent, with r2 of 0.90.

  17. Barriers and enablers to good communication and information-sharing practices in care planning for chronic condition management. (United States)

    Lawn, Sharon; Delany, Toni; Sweet, Linda; Battersby, Malcolm; Skinner, Timothy


    Our aim was to document current communication and information-sharing practices and to identify the barriers and enablers to good practices within the context of care planning for chronic condition management. Further aims were to make recommendations about how changes to policy and practice can improve communication and information sharing in primary health care. A mixed-method approach was applied to seek the perspectives of patients and primary health-care workers across Australia. Data was collected via interviews, focus groups, non-participant observations and a national survey. Data analysis was performed using a mix of thematic, discourse and statistical approaches. Central barriers to effective communication and information sharing included fragmented communication, uncertainty around client and interagency consent, and the unacknowledged existence of overlapping care plans. To be most effective, communication and information sharing should be open, two-way and inclusive of all members of health-care teams. It must also only be undertaken with the appropriate participant consent, otherwise this has the potential to cause patients harm. Improvements in care planning as a communication and information-sharing tool may be achieved through practice initiatives that reflect the rhetoric of collaborative person-centred care, which is already supported through existing policy in Australia. General practitioners and other primary care providers should operationalise care planning, and the expectation of collaborative and effective communication of care that underpins it, within their practice with patients and all members of the care team. To assist in meeting these aims, we make several recommendations.

  18. Evaluation of Critical Operating Conditions for a Semi-batch Reactor by Complementary Use of Sensitivity and Divergence Criteria


    Maria, G; Stefan, D.-N.


    This paper presents a comparison of several effective methods of deriving the critical feeding conditions for the case of a semi-batch catalytic reactor used for the acetoacetylation of pyrrole with diketene in homogeneous liquid phase. The reaction is known to be of high risk due to the very exothermic (polymerisation) side-reactions involving reactive diketene. In order to perform the sensitivity analysis, both the Morbidelli-Varma sensitivity criterion and div-methods were used, the latter...

  19. Sensitivity analysis of helicopter IMC decelerating steep approach and landing performance to navigation system parameters. [Instrument Meteorological Conditions (United States)

    Karmali, M. S.; Phatak, A. V.; Bull, J. S.; Peach, L. L.; Demko, P. S.


    The present investigation is concerned with a sensitivity analysis of the Decelerated Steep Approach and Landing (DSAL) maneuver to on-board and ground-based navigation system parameters. The Instrument Meteorological Conditions (IMC) DSAL maneuver involves decelerating to zero range rate while tracking the localizer and glideslope. The considered study investigated the performance of the navigation systems using Constant Deceleration Profile (CDP) guidance and a six degrees glideslope trajectory. A closed-loop computer simulation of the UH1H helicopter DSAL system was developed for the sensitivity analysis. Conclusions on system performance parameter sensitivity are discussed.

  20. Sensitivity of the last glacial inception to initial and surface conditions

    Energy Technology Data Exchange (ETDEWEB)

    Kubatzki, Claudia [Potsdam-Institut fuer Klimafolgenforschung e.V., Potsdam (Germany); Alfred-Wegener-Institut fuer Polar- und Meeresforschung, Bremerhaven (Germany); Claussen, Martin [Potsdam-Institut fuer Klimafolgenforschung e.V., Potsdam (Germany); Hamburg Univ. (Germany). Meteorologisches Inst.; Max-Planck-Institut fuer Meteorologie, Hamburg (Germany); Calov, Reinhard; Ganopolski, Andrey [Potsdam-Institut fuer Klimafolgenforschung e.V., Potsdam (Germany)


    We investigate the sensitivity of simulations of the last glacial inception (LGI) with respect to initial (size of the Greenland ice sheet) and surface (state of ocean/vegetation) conditions and two different CO{sub 2} reconstructions. Utilizing the CLIMBER-2 Earth system model, we obtain the following results: (a) ice-sheet expansion in North America at the end of the Eemian can be reduced or even completely suppressed when pre-industrial or Eemian ocean/vegetation is prescribed. (b) A warmer surrounding ocean and, in particular, a large Laurentide ice sheet reduce the size of the Greenland ice sheet before and during the LGI. (c) A changing ocean contributes much stronger to the expansion of the Laurentide ice sheet when we apply the CO{sub 2} reconstruction according to Barnola et al. (Nature 329:408-414, 1987) instead of Petit et al. (Nature 399:429-436, 1999). (d) In the fully coupled model, the CO{sub 2} reconstruction used has only a small impact on the simulated ice sheets but it does impact the course of the climatic variables. (e) For the Greenland ice sheet, two equilibrium states exist under the insolation and CO{sub 2} forcing at 128,000 years before present (128 kyear BP); the one with an ice sheet reduced by about one quarter as compared to its simulated pre-industrial size and the other with nearly no inland ice in Greenland. (f) Even the extreme assumption of no ice sheet in Greenland at the beginning of our transient simulations does not alter the simulated expansion of northern hemispheric ice sheets at the LGI. (orig.)

  1. Absolute Depth Sensitivity in Cat Primary Visual Cortex under Natural Viewing Conditions. (United States)

    Pigarev, Ivan N; Levichkina, Ekaterina V


    Mechanisms of 3D perception, investigated in many laboratories, have defined depth either relative to the fixation plane or to other objects in the visual scene. It is obvious that for efficient perception of the 3D world, additional mechanisms of depth constancy could operate in the visual system to provide information about absolute distance. Neurons with properties reflecting some features of depth constancy have been described in the parietal and extrastriate occipital cortical areas. It has also been shown that, for some neurons in the visual area V1, responses to stimuli of constant angular size differ at close and remote distances. The present study was designed to investigate whether, in natural free gaze viewing conditions, neurons tuned to absolute depths can be found in the primary visual cortex (area V1). Single-unit extracellular activity was recorded from the visual cortex of waking cats sitting on a trolley in front of a large screen. The trolley was slowly approaching the visual scene, which consisted of stationary sinusoidal gratings of optimal orientation rear-projected over the whole surface of the screen. Each neuron was tested with two gratings, with spatial frequency of one grating being twice as high as that of the other. Assuming that a cell is tuned to a spatial frequency, its maximum response to the grating with a spatial frequency twice as high should be shifted to a distance half way closer to the screen in order to attain the same size of retinal projection. For hypothetical neurons selective to absolute depth, location of the maximum response should remain at the same distance irrespective of the type of stimulus. It was found that about 20% of neurons in our experimental paradigm demonstrated sensitivity to particular distances independently of the spatial frequencies of the gratings. We interpret these findings as an indication of the use of absolute depth information in the primary visual cortex.

  2. Gas migration in KBS-3 buffer bentonite. Sensitivity of test parameters to experimental boundary conditions

    Energy Technology Data Exchange (ETDEWEB)

    Harrington, J.F.; Horseman, S.T. [British Geological Survey, Nottingham (United Kingdom)


    In the current Swedish repository design concept, hydrogen gas can be generated inside a waste canister by anaerobic corrosion of the ferrous metal liner. If the gas generation rate exceeds the diffusion rate of gas molecules in the buffer porewater, gas will accumulate in the void-space of a canister until its pressure becomes large enough for it to enter the bentonite as a discrete gaseous phase. Three long tenn gas injection tests have been performed on cylinders of pre-compacted MX80 bentonite. Two of these tests were undertaken using a custom-designed constant volume and radial flow (CVRF) apparatus. Gas was injected at a centrally located porous filter installed in the clay before hydration. Arrangements were made for gas to flow to three independently monitored sink-filter arrays mounted around the specimen. Axial and radial total stresses and internal porewater pressures were continuously monitored. Breakthrough and peak gas pressures were substantially larger than the sum of the swelling pressure and the external porewater. The third test was performed. using an apparatus which radially constrains the specimen during gas flow. Observed sensitivity of the breakthrough and peak gas pressures to the test boundary conditions suggests that gas entry must be accompanied by dilation of the bentonite fabric. In other words, there is a tendency for the volume of the specimen to increase during this process. The experimental evidence is consistent with the flow of gas along a relatively small number of crack-like pathways which propagate through the clay as gas pressure increases. Gas entry and breakthrough under constant volume boundary conditions causes a substantial increase in the total stress and the internal porewater pressure. It is possible to determine the point at which gas enters the clay by monitoring changes in these parameters. Localisation of gas flow within multiple pathways results, in nonuniform discharge rates at the sinks. When gas injection

  3. The optimal condition of performing MTT assay for the determination of radiation sensitivity

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Semie; Kim, Il Han [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)


    The measurement of radiation survival using a clonogenic assay, the established standard, can be difficult and time consuming. In this study, We have used the MTT assay, based on the reduction of a tetrazolium salt to a purple formazan precipitate by living cells, as a substitution for clonogenic assay and have examined the optimal condition for performing this assay in determination of radiation sensitivity. Four human cancer cell lines - PCI-1, SNU-1066, NCI-H63O and RKO cells have been used. For each cell line, a clonogenic assay and a MTT assay using Premix WST-1 solution, which is one of the tetrazolium salts and does not require washing or solubilization of the precipitate were carried out after irradiation of 0, 2, 4, 6, 8, 10 Gy, For clonogenic assay, cells in 25 cm{sup 2} flasks were irradiated after overnight incubation and the resultant colonies containing more than 50 cells were scored after culturing the cells for 10-14 days, For MTT assay, the relationship between absorbance and cell number, optimal seeding cell number, and optimal timing of assay was determined. Then, MTT assay was performed when the irradiated cells had regained exponential growth or when the non-irradiated cells had undergone four or more doubling times. There was minimal variation in the values gained from these two methods with the standard deviation generally less than 5%, and there were no statistically significant differences between two methods according to t-test in low radiation dose (below 6 Gy). The regression analyses showed high linear correlation with the R{sup 2} value of 0.975-0.992 between data from the two different methods. The optimal cell numbers for MTT assay were found to be dependent on plating efficiency of used cell line. Less than 300 cells/well were appropriate for cells with high plating efficiency (more than 30%). For cells with low plating efficiency (less than 30%), 500 cells/well or more were appropriate for assay. The optimal time for MTT assay was

  4. Making sense of high sensitivity troponin assays and their role in clinical care. (United States)

    Daniels, Lori B


    Cardiac troponin assays have an established and undisputed role in the diagnosis and risk stratification of patients with acute myocardial infarction. As troponin assays gets more sensitive and more precise, the number of potential uses has rapidly expanded, but the use of this test has also become more complicated and controversial. Highly sensitive troponin assays can now detect troponin levels in most individuals, but accurate interpretation of these levels requires a clear understanding of the assay in the context of the clinical scenario. This paper provides a practical and up-to-date overview of the uses of highly sensitive troponin assays for diagnosis, prognosis, and risk stratification in clinical practice.

  5. Does unemployment in family affect pregnancy outcome in conditions of high quality maternity care?

    Directory of Open Access Journals (Sweden)

    Heinonen Seppo


    Full Text Available Abstract Background The influence of unemployment in the family on pregnancy outcome is controversial. Only a few studies have involved investigation of the effect of unemployment of the father on pregnancy. The objective of this study was to assess the effects of unemployment of one or both parents on obstetric outcome in conditions of free antenatal care attended by the entire pregnant population. Methods The data of 24 939 pregnancies included maternal risk factors, pregnancy characteristics and outcome, and was based on a self administered questionnaire at 20 weeks of pregnancy and on clinical records. Results Unemployment was associated with adolescent maternal age, unmarried status and overweight, anemia, smoking, alcohol consumption and prior pregnancy terminations. Multivariate logistic regression analysis indicated that after controlling for these maternal risk factors small differences only were found in pregnancy outcomes between unemployed and employed families. Unemployed women had significantly more often small-for-gestational-age (SGA infants, at an OR of 1.26 (95% CI: 1.12 – 1.42 whereas, in families where both parents were unemployed, the risk of SGA was even higher at an OR of 1.43 (95% CI: 1.18 – 1.73. Otherwise, pregnancy outcome was comparable in the groups studied. Conclusion Free antenatal care was unable to fully overcome the adverse pregnancy outcomes associated with unemployment, SGA risk being highest when both parents are unemployed.

  6. Post-trial dopaminergic modulation of conditioned catalepsy: A single apomorphine induced increase/decrease in dopaminergic activation immediately following a conditioned catalepsy response can reverse/enhance a haloperidol conditioned and sensitized catalepsy response. (United States)

    Oliveira, Lucas Rangel; Dias, Flávia Regina Cruz; Santos, Breno Garone; Silva, Jade Leal Loureiro; Carey, Robert J; Carrera, Marinete Pinheiro


    Haloperidol can induce catalepsy and this drug effect can be conditioned as well as sensitized to contextual cues. We used a paired/unpaired Pavlovian conditioning protocol to establish haloperidol catalepsy conditioned and sensitized responses. Groups of rats were given 10 daily catalepsy tests following administration of vehicle (n=24) or haloperidol (1.0mg/kg) either paired (n=18) or unpaired (n=18) to testing. Subsequently, testing for conditioning was conducted and conditioning and sensitization of catalepsy were observed selectively in the paired group. Immediately following a second test for catalepsy conditioning, the groups were subdivided into 4 vehicle groups, 3 unpaired haloperidol groups and 3 paired haloperidol groups and were given one of three post-trial treatments (vehicle, 0.05mg/kg or 2.0mg/kg apomorphine). One day later the conditioned catalepsy test 3 was carried out and on the next day, a haloperidol challenge test was performed. The post-trial apomorphine treatments had major effects on the paired groups upon both conditioning and the haloperidol challenge test. The low dose apomorphine post-trial treatment enhanced both the conditioned and the haloperidol sensitized catalepsy responses. The high dose apomorphine post-trial treatment eliminated conditioned catalepsy and eliminated the initial acute catalepsy response to haloperidol that was induced in the vehicle control groups. These results demonstrate the sensitivity of conditioned drug cues to modification by increases/decreases in activity of the dopamine system in the immediate post-trial interval after a conditioning trial. This demonstration that post-trial dopaminergic drug treatments can modify conditioned drug behavior has broad implications for conditioned drug effects.

  7. Social demographic aspects and self-referred health conditions of men attending a health care unit

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    Raissa de Oliveira Martins Cabacinha


    Full Text Available This study aimed at characterizing social demographic aspects and health conditions of men attending a Primary Family Health Care unit in Montes Claros, MG, Brazil, correlating these variables with health self-perception and identifying men’s difficulty in using the health service. 115 adult men were interviewed who had attended the service in April and May, 2013. Most of them had completed high school, were married and adopted healthy practices, although they consumed alcoholic beverages. The main complaint regarding the health service was the long waiting time for attendance. The main factors that contributed for negative self-perception of health were: being married, suffering from chronic diseases and having low education; whereas those that contributed to the positive self-perception of health were: being young, being employed and not making regular use of medication (p<0.05. Those findings can subsidize policies to prevent diseases in promoting men’s health.


    Directory of Open Access Journals (Sweden)

    Idrees Ali Zahid


    Full Text Available Bacteriology of endometritis and in vitro antibiotic sensitivity of the isolates in Holstein Friesian and Jersey cows maintained at Research Institute for Physiology of Animal Reproduction, Bhunikey, District Kasur were carried out. Out of 100 samples, 89 contained different strains of bacteria and 11 were found bacteriologically sterile. Different species of bacteria isolated from these samples were, Bacillus subtilis (08.99%, Corynebacterium pyogenes (19.10%, Escherichia coli (29.21%, Neisseria meningitides (03.37%, Staphylococcus aureus (23.60%, Streptococcus pneumonia (03.37% and Streptococcus pyogenes (12.36%. The in vitro antibiotic sensitivity test indicated that the highest number of isolates (92% were sensitive to neomycin, followed by doxycyline (89%. Clindramycin showed the lowest results in terms of in vitro antibiotic sensitivity (51%.

  9. Sensitivity of modelled channel network formation to environmental conditions and initial bathymetry (United States)

    van Maanen, Barend; Coco, Giovanni; Bryan, Karin


    which feed back into the hydrodynamic part of the model, thus coupling the different subsystems of the morphodynamic feedback loop. Hydrodynamic conditions are assumed to remain constant unless significant changes in the morphology have occurred. This allows us to reduce numerical effort and facilitates the execution of long-term simulations. Modelling results indicate that the morphodynamic interactions can cause channel initiation and potentially give rise to channel pattern development. A sensitivity analysis is performed to show that the sediment grain size and tidal range mainly affect the timescale over which channel initiation occurs. We also varied the initial depth of the basin to assess the influence of initial bathymetry on morphological change. Channels start to form rapidly in the case of a shallow basin. When the basin is deeper, the bathymetry evolves differently in a remarkable way. While channels develop in the upper part of the basin, a flood-tidal delta forms simultaneously just landward of the inlet. Eventually, this flood delta channelizes and a complete tidal channel network develops. Additional simulations also indicate that effects related to climate change (i.e. sea level rise) highly affect the overall morphological evolution of tidal environments.

  10. Treated wastewater irrigation: uptake of pharmaceutical and personal care products by common vegetables under field conditions. (United States)

    Wu, Xiaoqin; Conkle, Jeremy L; Ernst, Frederick; Gan, Jay


    Global water shortage is placing an unprecedented pressure on water supplies. Treated wastewater is a valuable water resource, but its reuse for agricultural irrigation faces a roadblock: the public concern over the potential accumulation of contaminants of emerging concern (CECs) into human diet. In the present study, we measured the levels of 19 commonly occurring pharmaceutical and personal care products (PPCPs) in 8 vegetables irrigated with treated wastewater under field conditions. Tertiary treated wastewater without or with a fortification of each PPCP at 250 ng/L, was used to irrigate crops until harvest. Plant samples at premature and mature stages were collected. Analysis of edible tissues showed a detection frequency of 64% and 91% in all vegetables from the treated wastewater and fortified water treatments, respectively. The edible samples from the two treatments contained the same PPCPs, including caffeine, meprobamate, primidone, DEET, carbamazepine, dilantin, naproxen, and triclosan. The total concentrations of PPCPs detected in edible tissues from the treated wastewater and fortified irrigation treatments were in the range of 0.01-3.87 and 0.15-7.3 ng/g (dry weight), respectively. Annual exposure of PPCPs from the consumption of mature vegetables irrigated with the fortified water was estimated to be only 3.69 μg per capita. Results from the present study showed that the accumulation of PPCPs in vegetables irrigated with treated wastewater was likely limited under field conditions.

  11. High sensitivity point-of-care device for direct virus diagnostics

    DEFF Research Database (Denmark)

    Kiilerich-Pedersen, Katrine; Dapra, Johannes; Cherré, Solène


    Influenza infections are associated with high morbidity and mortality, carry the risk of pandemics, and pose a considerable economic burden worldwide. To improve the management of the illness, it is essential with accurate and fast point-of-care diagnostic tools for use in the field or at the pat......Influenza infections are associated with high morbidity and mortality, carry the risk of pandemics, and pose a considerable economic burden worldwide. To improve the management of the illness, it is essential with accurate and fast point-of-care diagnostic tools for use in the field...... of its usability. An all polymer microfluidic system with a functionalized conductive polymer (PEDOT-OH:TsO) microelectrode array was developed and exploited for label free and real time electrochemical detection of intact influenza A virus (H1N1) particles. DNA aptamers with affinity for influenza...

  12. The Process of Interactional Sensitivity Coding in Health Care: Conceptually and Operationally Defining Patient-Centered Communication. (United States)

    Sabee, Christina M; Koenig, Christopher J; Wingard, Leah; Foster, Jamie; Chivers, Nick; Olsher, David; Vandergriff, Ilona


    This study aimed to develop a process for measuring sensitivity in provider-patient interactions to better understand patient-centered communication. The authors developed the Process of Interactional Sensitivity Coding in Healthcare (PISCH) by incorporating a multimethod investigation into conversations between physicians and their patients with type 2 diabetes. The PISCH was then applied and assessed for its reliability across the unitization of interactions, the activities that were reflected, and the characteristics of patient-centered interactional sensitivity that were observed within each unit. In most cases, the PISCH resulted in reliable analysis of the interactions, but a few key areas (shared decision making, enabling self-management, and responding to emotion) were not reliably assessed. Implications of the test of this coding scheme include the expansion of the theoretical notion of interactional sensitivity to the health care context, rigorous implementation of a multimethod measurement development that relied on qualitative and quantitative assessments, and important future questions about the role of communication concepts in future interpersonal research.

  13. Anxiety sensitivity and subjective social status in relation to anxiety and depressive symptoms and disorders among Latinos in primary care. (United States)

    Zvolensky, Michael J; Bakhshaie, Jafar; Garza, Monica; Valdivieso, Jeanette; Ortiz, Mayra; Bogiaizian, Daniel; Robles, Zuzuky; Vujanovic, Anka


    The present investigation examined the interactive effects of anxiety sensitivity and subjective social status in relation to anxiety and depressive symptoms and psychopathology among 143 Latinos (85.7% female; Mage=39.0, SD=10.9; 97.2% used Spanish as their first language) who attended a community-based primary healthcare clinic. Results indicated that the interaction between anxiety sensitivity and subjective social status was significantly associated with number of mood and anxiety disorders, panic, social anxiety, and depressive symptoms. The form of the significant interactions indicated that individuals reporting co-occurring higher levels of anxiety sensitivity and lower levels of subjective social status evidenced the greatest levels of psychopathology and panic, social anxiety, and depressive symptoms. The present findings suggest that there is merit in focusing further scientific attention on the interplay between anxiety sensitivity and subjective social status in regard to understanding, and thus, better intervening to reduce anxiety/depressive vulnerability among Latinos in primary care.

  14. Prenatal Choline Availability Alters the Context Sensitivity of Pavlovian Conditioning in Adult Rats (United States)

    Lamoureux, Jeffrey A.; Meck, Warren H.; Williams, Christina L.


    The effects of prenatal choline availability on Pavlovian conditioning were assessed in adult male rats (3-4 mo). Neither supplementation nor deprivation of prenatal choline affected the acquisition and extinction of simple Pavlovian conditioned excitation, or the acquisition and retardation of conditioned inhibition. However, prenatal choline…

  15. Variation In Accountable Care Organization Spending And Sensitivity To Risk Adjustment: Implications For Benchmarking. (United States)

    Rose, Sherri; Zaslavsky, Alan M; McWilliams, J Michael


    Spending targets (or benchmarks) for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program must be set carefully to encourage program participation while achieving fiscal goals and minimizing unintended consequences, such as penalizing ACOs for serving sicker patients. Recently proposed regulatory changes include measures to make benchmarks more similar for ACOs in the same area with different historical spending levels. We found that ACOs vary widely in how their spending levels compare with those of other local providers after standard case-mix adjustments. Additionally adjusting for survey measures of patient health meaningfully reduced the variation in differences between ACO spending and local average fee-for-service spending, but substantial variation remained, which suggests that differences in care efficiency between ACOs and local non-ACO providers vary widely. Accordingly, measures to equilibrate benchmarks between high- and low-spending ACOs--such as setting benchmarks to risk-adjusted average fee-for-service spending in an area--should be implemented gradually to maintain participation by ACOs with high spending. Use of survey information also could help mitigate perverse incentives for risk selection and upcoding and limit unintended consequences of new benchmarking methodologies for ACOs serving sicker patients.

  16. Computer aided diagnosis for mental health care : On the clinical validation of sensitive machines

    NARCIS (Netherlands)

    Sluis, F. van der; Dijkstra, T.; Broek, E.L. van den


    This study explores the feasibility of sensitive machines; that is, machines with empathic abilities, at least to some extent. A signal processing and machine learning pipeline is presented that is used to analyze data from two studies in which 25 Post-Traumatic Stress Disorder (PTSD) patients parti

  17. Rapid, high sensitivity, point-of-care test for cardiac troponin based on optomagnetic biosensor

    NARCIS (Netherlands)

    Dittmer, W.U.; Evers, T.H.; Hardeman, W.M.; Huijnen-Keur, W.M.; Kamps, R.; De Kievit, P.; Neijzen, J.H.M.; Sijbers, M.J.J.; Nieuwenhuis, J.H.; Hefti, M.H.; Dekkers, D.; Martens, M.


    BACKGROUND: We present a handheld integrated device based on a novel magnetic-optical technology for the sensitive detection of cardiactroponin I, a biomarker for the positive diagnosis of myocardial infarct, in a finger-prick blood sample. The test can be performed with a turn-around time of 5 min

  18. Sensitive Periods of Emotion Regulation: Influences of Parental Care on Frontoamygdala Circuitry and Plasticity (United States)

    Gee, Dylan G.


    Early caregiving experiences play a central role in shaping emotional development, stress physiology, and refinement of limbic circuitry. Converging evidence across species delineates a sensitive period of heightened neuroplasticity when frontoamygdala circuitry is especially amenable to caregiver inputs early in life. During this period, parental…

  19. [At the Savar center, primary health care (PHC) evolves with the health conditions]. (United States)

    Chirac, P


    A war hospital installed close to the front by a group of young Bangladeshi doctors during the 1971 war of liberation from Pakistan was the origin of the new "Gonoshasthaya Kendra" (GK), or people's health center, 40 km north of Dhaka in Savar. At the new center, as in the hospital, trained paramedics furnish basic health care for the population. The center at Savar was applying the principles of primary health care 6 years before they were recognized at the Alma Ata conference. Today, GK has integrated programs to fight poverty into its health activities, with educational, nutrition, and employment programs. The paramedics have a long training course, working under the supervision of a senior paramedic for a year and receiving theoretical training in the evenings. They do not become senior paramedics for several years. The work of the paramedics is oriented toward health education, prevention, and demoepidemiologic surveillance and registration. Each paramedic is responsible for 2 or 3 villages with about 3 thousand inhabitants. The paramedics visit and motivate the population, register births and deaths, identify and care for pregnant women, and vaccinate children and pregnant women. They provide health and nutrition education, treat diarrhea and instruct mothers in use of oral rehydration therapy, and provide family planning information and supplies. Persons in need are referred to "clinic days" held regularly in the larger villages. The paramedics maintain records for each family which allow calculation of vital rates and epidemiologic data. In the region of Savar served by the paramedics, the rates of general mortality and infant mortality are 12/1000 and 85/1000 respectively, vs. 17 and 124/1000 in Bangladesh as a whole. The GK has a new goal of reducing infant mortality to 60/1000. The paramedics have been taught to recognize 2 new symptoms, convulsions and respiratory distress, and to refer infants showing these symptoms to doctors. The GK doctors believe

  20. Sensitivity analyses of biodiesel thermo-physical properties under diesel engine conditions

    DEFF Research Database (Denmark)

    Cheng, Xinwei; Ng, Hoon Kiat; Gan, Suyin


    This reported work investigates the sensitivities of spray and soot developments to the change of thermo-physical properties for coconut and soybean methyl esters, using two-dimensional computational fluid dynamics fuel spray modelling. The choice of test fuels made was due to their contrasting...... saturation-unsaturation compositions. The sensitivity analyses for non-reacting and reacting sprays were carried out against a total of 12 thermo-physical properties, at an ambient temperature of 900 K and density of 22.8 kg/m3. For the sensitivity analyses, all the thermo-physical properties were set...... as the baseline case and each property was individually replaced by that of diesel. The significance of individual thermo-physical property was determined based on the deviations found in predictions such as liquid penetration, ignition delay period and peak soot concentration when compared to those of baseline...

  1. Use of the interRAI CHESS scale to predict mortality among persons with neurological conditions in three care settings.

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    John P Hirdes

    Full Text Available BACKGROUND: Persons with certain neurological conditions have higher mortality rates than the population without neurological conditions, but the risk factors for increased mortality within diagnostic groups are less well understood. The interRAI CHESS scale has been shown to be a strong predictor of mortality in the overall population of persons receiving health care in community and institutional settings. This study examines the performance of CHESS as a predictor of mortality among persons with 11 different neurological conditions. METHODS: Survival analyses were done with interRAI assessments linked to mortality data among persons in home care (n = 359,940, complex continuing care hospitals/units (n = 88,721, and nursing homes (n = 185,309 in seven Canadian provinces/territories. RESULTS: CHESS was a significant predictor of mortality in all 3 care settings for the 11 neurological diagnostic groups considered after adjusting for age and sex. The distribution of CHESS scores varied between diagnostic groups and within diagnostic groups in different care settings. CONCLUSIONS: CHESS is a valid predictor of mortality in neurological populations in community and institutional care. It may prove useful for several clinical, administrative, policy-development, evaluation and research purposes. Because it is routinely gathered as part of normal clinical practice in jurisdictions (like Canada that have implemented interRAI assessment instruments, CHESS can be derived without additional need for data collection.

  2. Role of Occupational Therapy in Case Management and Care Coordination for Clients With Complex Conditions. (United States)

    Robinson, Monica; Fisher, Thomas F; Broussard, Kim


    Specific aspects of the profession of occupational therapy support a distinct value for its practitioners participating fully in the development of case management and care coordination systems. The expectation in the 21st century is that the U.S. health care system must be transformed from one that promotes volume of service to one that promotes value of care. Case management and care coordination will be critical components of that transformation. Occupational therapy's principles, education, practice, approach, and perspective offer much to benefit this increased attention to case management and care coordination. Occupational therapy practitioners should promote themselves and their profession as these system changes develop.

  3. Supply sensitive services in Swiss ambulatory care: An analysis of basic health insurance records for 2003-2007

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    Künzi Beat


    Full Text Available Abstract Background Swiss ambulatory care is characterized by independent, and primarily practice-based, physicians, receiving fee for service reimbursement. This study analyses supply sensitive services using ambulatory care claims data from mandatory health insurance. A first research question was aimed at the hypothesis that physicians with large patient lists decrease their intensity of services and bill less per patient to health insurance, and vice versa: physicians with smaller patient lists compensate for the lack of patients with additional visits and services. A second research question relates to the fact that several cantons are allowing physicians to directly dispense drugs to patients ('self-dispensation' whereas other cantons restrict such direct sales to emergencies only. This second question was based on the assumption that patterns of rescheduling patients for consultations may differ across channels of dispensing prescription drugs and therefore the hypothesis of different consultation costs in this context was investigated. Methods Complete claims data paid for by mandatory health insurance of all Swiss physicians in own practices were analyzed for the years 2003-2007. Medical specialties were pooled into six main provider types in ambulatory care: primary care, pediatrics, gynecology & obstetrics, psychiatrists, invasive and non-invasive specialists. For each provider type, regression models at the physician level were used to analyze the relationship between the number of patients treated and the total sum of treatment cost reimbursed by mandatory health insurance. Results The results show non-proportional relationships between patient numbers and total sum of treatment cost for all provider types involved implying that treatment costs per patient increase with higher practice size. The related additional costs to the health system are substantial. Regions with self-dispensation had lowest treatment cost for primary care

  4. Caring for people with multiple chronic conditions in the United Kingdom: policy and practices with a focus on England and Scotland.

    NARCIS (Netherlands)

    Bramwell, C.; Don, R.M.; Porter, I.; Lloyd, H.; Kadam, U.; Rijken, M.; Valderas, J.M.


     General Practice (Primary Care) is responsible for the provision of health care for people with chronic conditions in the UK. General Practitioners (GPs) and practice nurses play a key role in the coordination of care with input from secondary care specialists.  The prevalence of coexisting chro

  5. Multiple Comorbid Conditions among Middle-Aged and Elderly Hemophilia Patients: Prevalence Estimates and Implications for Future Care

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    Aroub A. Khleif


    Full Text Available Introduction. Advances in hemophilia care and treatment have led to increases in the life expectancy among hemophiliacs. As a result, persons with hemophilia are reaching an older age and experiencing various age-related health conditions never seen before in this population. Aim. To determine the prevalence of comorbidities among middle-aged and elderly hemophilia A and hemophilia B patients. Methods. Retrospective chart review among all hemophilia patients, who attended the Gulf States Hemophilia and Thrombophilia Center. Results. All patients had at least one comorbid condition other than hemophilia, and the majority had between 3 and 6 comorbidities. The most common conditions identified were chronic hepatitis C, hypertension, HIV, chronic arthropathy, and overweight/obesity. Conclusions. Since persons with comorbidities are more likely to have poorer health outcomes and require greater care in managing their health needs, caring for aging hemophiliacs is likely to pose various social and economic challenges for both patients and providers.

  6. Evaluation of portable point-of-care CD4 counter with high sensitivity for detecting patients eligible for antiretroviral therapy.

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    Yukari C Manabe

    Full Text Available BACKGROUND: Accurate, inexpensive point-of-care CD4+ T cell testing technologies are needed that can deliver CD4+ T cell results at lower level health centers or community outreach voluntary counseling and testing. We sought to evaluate a point-of-care CD4+ T cell counter, the Pima CD4 Test System, a portable, battery-operated bench-top instrument that is designed to use finger stick blood samples suitable for field use in conjunction with rapid HIV testing. METHODS: Duplicate measurements were performed on both capillary and venous samples using Pima CD4 analyzers, compared to the BD FACSCalibur (reference method. The mean bias was estimated by paired Student's t-test. Bland Altman plots were used to assess agreement. RESULTS: 206 participants were enrolled with a median CD4 count of 396 (range; 18-1500. The finger stick PIMA had a mean bias of -66.3 cells/µL (95%CI -83.4-49.2, P500 cells/µL with a mean bias of -120.6 (95%CI -162.8, -78.4, P<0.001. The sensitivity (95%CI of the Pima CD4 analyzer was 96.3% (79.1-99.8% for a <250 cells/ul cut-off with a negative predictive value of 99.2% (95.1-99.9%. CONCLUSIONS: The Pima CD4 finger stick test is an easy-to-use, portable, relatively fast device to test CD4+ T cell counts in the field. Issues of negatively-biased CD4 cell counts especially at higher absolute numbers will limit its utility for longitudinal immunologic response to ART. The high sensitivity and negative predictive value of the test makes it an attractive option for field use to identify patients eligible for ART, thus potentially reducing delays in linkage to care and ART initiation.

  7. Organic particulate material levels in the atmosphere: conditions favoring sensitivity to varying relative humidity and temperature. (United States)

    Pankow, James F


    This study examines the sensitivity in predicted levels of atmospheric organic particulate matter (M(o), microg m(-3)) as those levels may potentially be affected by changes in relative humidity and temperature. In a given system, for each partitioning compound, f(g) and f(p) represent the gaseous and particulate fractions (f(g) + f(p) = 1). Sensitivity in the M(o) levels becomes dampened as the compounds contributing significantly to M(o) are increasingly found in the particle phase (f(p) --> 1). Thus, although local maxima in sensitivity can be encountered as M(o) levels increase, because as M(o) increases each f(p) --> 1, then increasing M(o) levels generally tend to reduce sensitivity in M(o) levels to changes in relative humidity and temperature. Experiments designed to elucidate the potential magnitudes of the effects of relative humidity and temperature on M(o) levels must be carried out at M(o) levels that are relevant for the ambient atmosphere: The f(p) values for the important partitioning compounds must not be elevated above ambient-relevant values. Systems in which M(o) levels are low (e.g., 1-2 microg m(-3)) and/or composed of unaged secondary organic aerosol are the ones most likely to show sensitivity to changing relative humidity and temperature. Results from two published chamber studies are examined in the above regard: [Warren B, et al. (2009) Atmos Environ 43:1789-1795] and [Prisle NL, et al. (2010) Geophys Res Lett 37:L01802].

  8. No systemic reactions to influenza vaccination in egg-sensitized tertiary-care pediatric patients

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    Upton Julia


    Full Text Available Abstract Background There are numerous, disparate guidelines for influenza vaccination in egg-allergic patients. We aimed to describe the outcome of selectively applied guidelines, based on risk-stratification, to our high risk, egg-allergic, tertiary-care pediatric population. Methods Egg allergy was confirmed with skin testing. The vaccine administered was an adjuvunated 2009 H1N1 influenza A vaccine with Results Ninety-nine patients were referred and 79 had positive egg testing. Asthma was present in 67% and 30% had prior anaphylaxis to egg. We vaccinated 77 of 79 patients: 71 without performing vaccine skin testing. Two refused vaccination. No patient had a systemic reaction or required treatment. Two patients experienced positive testing to the adjuvanated intradermal vaccine, but were negative without adjuvant. Conclusions Our results suggest that most egg-allergic tertiary care pediatric patients can be vaccinated with a low ovalbumin content influenza vaccine without prior vaccine testing. Vaccine skin testing, if used at all, can be reserved for special circumstances. The squalene adjuvant may cause an irritant reaction with intradermal testing.

  9. [Dispensing care at the dispensing counter in the conditions of a Czech pharmacy]. (United States)

    Macesková, B; Plevacová, H


    Evaluation of 108 cases when the pharmacist found a need to intervene into prescription verified the use of internationally employed system of classification of pharmaceutical interventions in the conditions of the Czech pharmacy of the basic type. The so-called dispensing care at the counter was provided by five participating pharmacists (out of seven working in the pharmacy) for a period of six months. The most frequently identified problems included: inappropriate use of medicaments--overdose, use at unsuitable time (28.7 %), a need to inform the patient (17.6 %), potentially ineffective therapy (12.9 %), drug interactions (7.4 %), suspected and potential undesirable effects of prescribed medicaments (7.4 %), and insufficient compliance (6.5 %). Solution of problems with medicaments was most frequently: a change in dosage (25.9 %), recommendation to consult the physician (24.1 %), and professional counselling on pharmacotherapy (23.1 %). The pharmacotherapeutic group identified as the one most frequently requiring a telephone consultation of the pharmacist and the physician was antibiotics, including antibacterial chemotherapeutic agents.

  10. Is fumigation enough for air conditioning units in operation theatres and Intensive care units?

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    Anasua Deb


    Full Text Available Background: Strict asepsis is necessary in operating theatres (OT and intensive care units (ICU as the patients undergo invasive procedures. The filters of contaminated air conditioning (AC units provide a niche for proliferation of fungi and production of fungal spores. Methods: The routine procedure for maintenance of sterile atmosphere in our hospital, i.e. fumigation and mopping walls with disinfectants often fail to address these fungal spores of the AC filters. We therefore carried out a surveillance of the ACs in ICUs and OTs to find the level of contamination with fungal spores and also to improvise on intervention strategies to tackle the problem. Over 3 months period, 34 ACs from 7 OTs and 2 ICUs were screened by taking 2 swabs from each AC which were then tested for the presence of fungal spores as per standard methods. Results: The contamination rate was 88.2% before fumigation and 76.9% after fumigation. The fungal spore contamination rate was reduced to 20% (1 out of 5 ACs after servicing of the ACs was done. Aspergillus spp. was the most common fungal isolate. Conclusion: Based on the observations, we recommend regular servicing of the ACs as well as wet mopping of the ducts with sporicidal solution at regular intervals. [Int J Res Med Sci 2016; 4(5.000: 1583-1589

  11. Who can afford health care? Evaluating the socio-economic conditions and the ability to contribute to health care in a post-conflict area in DR Congo.

    Directory of Open Access Journals (Sweden)

    Sibylle Gerstl

    Full Text Available INTRODUCTION: The Democratic Republic of the Congo is today one of the poorest countries in the world; the health status of the population ranks among the worst in Sub-Saharan Africa. Public health services charge user fees and drug prices. Since 2008, north-eastern Congo is facing a guerrilla war. Malteser International is assisting with free health care for internally displaced persons as well as the general population. Before the incursion the health system was based on user fees. The aim of this study was to determine the socio-economic conditions of the population and to assess their ability to contribute to health care. METHODOLOGY: Heads of 552 randomly selected households in 23 clusters in two health zones were interviewed using a standardised questionnaire. FINDINGS: The demographic description and socio-economic conditions of the study population were homogenous. Major source of income was agriculture (57%; 47% of the households earned less than US$ 5.5/week. Ninety-two percent of the interviewed households estimated that they would be able to contribute to consultation fees (maximum amount of US$ 0.27 and 79% to the drug prices (maximum amount of US$ 1.10. Six percent opted for free consultations and 19% for free drugs. CONCLUSIONS: Living conditions were very basic; the estimated income of the study population was low. Almost half of the population perceived their current living situation as fairly good/good. More than 90% of the study population estimated to be able to contribute to consultation fees and 80% to drug prices. As a result Malteser International suggested introducing flat-rates for health care services. Once the project ends, the population will have to pay again for their health service. One solution would be the introduction of a health care financing system with the goal to reach universal coverage to health care.

  12. [Primary Care Health Houses: a new balance between continuity, accessibility of care and health professionals working conditions?]. (United States)

    Clément, Marie-Caroline; Couralet, Pierre-Emmanuel; Mousquès, Julien; Pierre, Aurélie; Bourgueil, Yann


    This evaluation explore empirically, the concept of Multidisciplinary Health Houses, considered as a solution to maintain GP's in remote areas and simultaneously to improve quality of care. Our sample concern 9 health Houses, 71 health professionals of which 32 GP's in two regions. We mixed data collected by questionnaire, visits and interviews. Professional activity and consumptions of care by patients were assessed with claims data from national sickness fund database. Comparison was made with professionals and patients of local zones for each Health Houses. Beyond heterogeneity of health houses in terms of location, size, number of professionals involved, we found a higher level of equipment than average practices, larger access in the day, the week and the year and many informal collaboration. With the same medical activity, doctors declare to have longer holidays. Different level of collaboration can be identified according to the level of substitution between them to their patients. To conclude, Multidisciplinary Health Houses enable GP's to find new balance between work and leisure time and offers larger time accessibility to patients.

  13. Sensitivity of ICF ignition conditions to non-Maxwellian DT fusion reactivity

    Directory of Open Access Journals (Sweden)

    Garbett W.J.


    Full Text Available The hotspot ignition conditions in ICF are determined by considering the power balance between fusion energy deposition and energy loss terms. Uncertainty in any of these terms has potential to modify the ignition conditions, changing the optimum ignition capsule design. This paper considers the impact of changes to the DT fusion reaction rate due to non-thermal ion energy distributions. The DT fusion reactivity has been evaluated for a class of non-Maxwellian distributions representing a perturbation to the tail of a thermal distribution. The resulting reactivity has been used to determine hotspot ignition conditions as a function of the characteristic parameter of the modified distribution.

  14. Forging partnerships between rural women with chronic conditions and their health care providers. (United States)

    Cudney, Shirley; Weinert, Clarann; Kinion, Elizabeth


    Successful adaptation to chronic illness is enhanced by active client-health care provider partnerships. The purposes of this article are to (a) examine the health care partnership needs of western rural women with chronic illness who participated in a computer-based support and education project, (b) describe how the role of the women in the partnership can be maximized by the use of a personal health record and improving health literacy, and (c) discuss ways health care providers can enhance their role in the partnership by careful listening and creating environments conducive to forging productive client-provider partnerships.

  15. Is disgust sensitive to classical conditioning as indexed by facial electromyography and behavioural responses? (United States)

    Borg, Charmaine; Bosman, Renske C; Engelhard, Iris; Olatunji, Bunmi O; de Jong, Peter J


    Earlier studies provided preliminary support for the role of classical conditioning as a pathway of disgust learning, yet this evidence has been limited to self-report. This study included facial electromyographical (EMG) measurements (corrugator and levator muscles) and a behavioural approach task to assess participants' motivation-to-eat the actual food items (conditioned stimuli, CS). Food items served as CS and film excerpts of a woman vomiting served as unconditioned stimuli (US). Following acquisition the CS+ (neutral CS paired with US disgust) was rated as more disgusting and less positive. Notably, the conditioned response was transferred to the actual food items as evidenced by participants' reported lowered willingness-to-eat. Participants also showed heightened EMG activity in response to the CS+ which seemed driven by the corrugator indexing a global negative affect. These findings suggest that classical conditioning as a pathway of disgust learning can be reliably observed in subjective but not in disgust-specific physiological responding.

  16. Reduced Numerical Model for Methane Hydrate Formation under Conditions of Variable Salinity. Time-Stepping Variants and Sensitivity

    Directory of Open Access Journals (Sweden)

    Malgorzata Peszynska


    Full Text Available In this paper, we consider a reduced computational model of methane hydrate formation in variable salinity conditions, and give details on the discretization and phase equilibria implementation. We describe three time-stepping variants: Implicit, Semi-implicit, and Sequential, and we compare the accuracy and efficiency of these variants depending on the spatial and temporal discretization parameters. We also study the sensitivity of the model to the simulation parameters and in particular to the reduced phase equilibria model.

  17. Point-Of-Care p24 Infant Testing for HIV May Increase Patient Identification despite Low Sensitivity (United States)

    Bollinger, Timothy; Mabunda, Nédio; Vubil, Adolfo; Tobaiwa, Ocean; Quevedo, Jorge I.; Loquiha, Osvaldo; Vojnov, Lara; Peter, Trevor F.; Jani, Ilesh V.


    The long delay in returning test results during early infant diagnosis of HIV (EID) often causes loss-to-follow-up prior to antiretroviral treatment (ART) initiation in resource-limited settings. A point-of-care (POC) test may help overcome these challenges. We evaluated the performance of the LYNX p24 Antigen POC test in Mozambique. 879 HIV-exposed infants under 18 months of age were enrolled consecutively at three primary healthcare clinics (PHC). Lancet heel-drawn blood was tested on-site by nurses using a prototype POC test for HIV Gag p24 antigen detection. Results of POC testing were compared to laboratory-based nucleic acid testing on dried blood spots. A comparison of the effect of sensitivity and timely test results return on successful diagnosis by POC and laboratory-based platforms was also calculated. The sensitivity and specificity of the LYNX p24 Ag test were 71.9%; (95% confidence interval [CI]: 58.5–83.0%) and 99.6% (95% CI: 98.9–99.9%), respectively. The predictive value of positive and negative tests were 93.2% (95% CI: 81.3–98.6%) and 97.9% (95% CI: 96.8–98.8%), respectively. Overall agreement was high (Cohen Kappa = 0.80; 95% CI: 0.71–0.89). Despite its lower sensitivity, the POC test had the potential to provide test results to up to 81% more patients compared to the laboratory-based test. This prototype POC p24 assay was feasible for use in PHCs but demonstrated low sensitivity for HIV detection. POC EID technologies that perform below standard recommendations may still be valuable diagnostic tools in settings with inefficient EID networks. PMID:28060886

  18. 42 CFR 418.56 - Condition of participation: Interdisciplinary group, care planning, and coordination of services. (United States)


    ... professional roles: (i) A doctor of medicine or osteopathy (who is an employee or under contract with the hospice). (ii) A registered nurse. (iii) A social worker. (iv) A pastoral or other counselor. (2) If the... their responsibilities for the care and services identified in the plan of care. (c) Standard:...

  19. Chronic intermittent heroin produces locomotor sensitization and long-lasting enhancement of conditioned reinforcement. (United States)

    Morrison, J; Thornton, V; Ranaldi, R


    In a previous study we showed that chronic intermittent heroin in rats enhanced responding with conditioned reinforcement and reversal learning of a conditioned magazine approach task when tested three days after the heroin treatment. Whether or not this enhanced appetitive learning persists after a protracted withdrawal period remains unknown and constitutes the aim of the present study. Forty-eight male Long Evans rats were each exposed to positive pairings of a light stimulus and food for 4 consecutive daily sessions. Then, two groups of rats received saline and two groups received heroin (2 mg/kg) injections before placement in activity monitors for 9 consecutive daily sessions. This was followed by testing in operant conditioning chambers where one lever produced the light stimulus previously paired with food and another no stimulus. For one saline and one heroin group this testing occurred after 2 days of withdrawal while for the other saline and heroin groups it occurred after 30 days of withdrawal. The results indicate that animals treated with heroin displayed progressively and significantly greater locomotor activity across sessions while animals treated with saline displayed locomotor activity that remained low and stable across sessions. In addition, the heroin groups in each withdrawal condition displayed significantly enhanced responding with conditioned reinforcement compared to their respective saline control groups. These results demonstrate that chronic intermittent heroin enhances appetitive learning for natural reinforcers and motivational processes and that this effect persists even after 30-days of withdrawal.

  20. Excess of health care use in general practice and of comorbid chronic conditions in cancer patients compared to controls

    Directory of Open Access Journals (Sweden)

    Jabaaij Lea


    Full Text Available Abstract Background The number of cancer patients and the number of patients surviving initial treatments is expected to rise. Traditionally, follow-up monitoring takes place in secondary care. The contribution of general practice is less visible and not clearly defined. This study aimed to compare healthcare use in general practice of patients with cancer during the follow-up phase compared with patients without cancer. We also examined the influence of comorbid conditions on healthcare utilisation by these patients in general practice. Methods We compared health care use of N=8,703 cancer patients with an age and gender-matched control group of patients without cancer from the same practice. Data originate from the Netherlands Information Network of General Practice (LINH, a representative network consisting of 92 general practices with 350,000 enlisted patients. Health care utilisation was assessed using data on contacts with general practice, prescription and referral rates recorded between 1/1/2001 and 31/12/2007. The existence of additional comorbid chronic conditions (ICPC coded was taken into account. Results Compared to matched controls, cancer patients had more contacts with their GP-practice (19.5 vs. 11.9, p Conclusion We found that cancer patients in the follow-up phase consulted general practice more often and suffered more often from comorbid chronic conditions, compared to patients without cancer. It is expected that the number of cancer patients will rise in the years to come and that primary health care professionals will be more involved in follow-up care. Care for comorbid chronic conditions, communication between specialists and GPs, and coordination of tasks then need special attention.

  1. Walsh-Hadamard Based 3D Steganography for Protecting Sensitive Information in Point-of-Care. (United States)

    Abuadbba, Alsharif; Khalil, Ibrahim


    Remote points-of-care has recently had a lot of attention for their advantages such as saving lives and cost reduction. The transmitted streams usually contain (1) normal biomedical signals (e.g. ECG) and (2) highly private information (e.g. patient identity). Despite the obvious advantages, the primary concerns are privacy and authenticity of the transferred data. Therefore, this paper introduces a novel steganographic mechanism that ensures (1) strong privacy preservation of private information by random concealing inside the transferred signals employing a key, and (2) evidence of originality for the biomedical signals. To maximize hiding, Fast Walsh-Hadamard Transform is utilized to transform the signals into a group of coefficients. To ensure the lowest distortion, only less-significant values of coefficients are employed. To strengthen security, the key is utilized in a 3-Dimensional random coefficients' reform to produce a 3D order employed in the concealing process. The resultant distortion has been thoroughly measured in all stages. After extensive experiments on three types of signals, it has been proven that the algorithm has little impact on the genuine signals (< 1 %). The security evaluation also confirms that unlawful retrieval of the hidden information within rational time is mightily improbable.

  2. Reaction norm model to describe environmental sensitivity across first lactation in dairy cattle under tropical conditions. (United States)

    Bignardi, Annaiza Braga; El Faro, Lenira; Pereira, Rodrigo Junqueira; Ayres, Denise Rocha; Machado, Paulo Fernando; de Albuquerque, Lucia Galvão; Santana, Mário Luiz


    Reaction norm models have been widely used to study genotype by environment interaction (G × E) in animal breeding. The objective of this study was to describe environmental sensitivity across first lactation in Brazilian Holstein cows using a reaction norm approach. A total of 50,168 individual monthly test day (TD) milk yields (10 test days) from 7476 complete first lactations of Holstein cattle were analyzed. The statistical models for all traits (10 TDs and for 305-day milk yield) included the fixed effects of contemporary group, age of cow (linear and quadratic effects), and days in milk (linear effect), except for 305-day milk yield. A hierarchical reaction norm model (HRNM) based on the unknown covariate was used. The present study showed the presence of G × E in milk yield across first lactation of Holstein cows. The variation in the heritability estimates implies differences in the response to selection depending on the environment where the animals of this population are evaluated. In the average environment, the heritabilities for all traits were rather similar, in range from 0.02 to 0.63. The scaling effect of G × E predominated throughout most of lactation. Particularly during the first 2 months of lactation, G × E caused reranking of breeding values. It is therefore important to include the environmental sensitivity of animals according to the phase of lactation in the genetic evaluations of Holstein cattle in tropical environments.

  3. Ventriculostomy related infection in intensive care unit:Diagnostic criteria and related conditions

    Institute of Scientific and Technical Information of China (English)

    Sergio Castaño ´Avila; Amaia Quintano Rodero; Ana Tejero Mojena; Alberto Manzano Ramírez; Esther Corral Lozano; Javier Maynar Moliner; Fernando Fonseca San Miguel; Elena Us ´on García; Yolanda Poveda Hern ´andez; Sara Cabañes Daro-Franc ´es; Goiatz Balziskueta Fl ´orez; Noemi Legaristi Martínez


    Objective: To evaluate the usefulness of clinical signs, blood tests, microbiological cultures and cerebrospinal fluid (CSF) analysis to detect ventriculostomy related in-fections (VRI), and to describe related conditions. Methods: A retrospective study was carried out including all patients with external ventricular drain admitted to intensive care unit from January 2000 to December 2006. Diagnosis of VRI, mortality, demographic and clinical data, time and number of drains, microbiological and biochemical CSF results and blood test were recorded. Difference between infected and uninfected patients was statistically significant at P Results: The results revealed 136 drainages in 120 patients with 22 (18.33%) infected (15.39 infections per 1 000 days of drainage). This group was on overage older, had more severe systemic response syndrome and a significantly higher number of drains and longer duration of drain insertion. We found statistical differences in proteinorrachia, glycorrhachia, and glycorrachia/glycemia ratio during 8.5-day drain insertion (inter-quartile range 7–10.25). A total of 31 cultures were positive in patients without VRI and 47 were negative in patients with VRI. Furthermore, 35 patients died (2 belonging to the infected group). Significantly higher risk of VRI in intraventricular fibrinolysis and subarachnoid haemorrhage was observed. We made a multivariate regression model resulting in a prediction rule with 55.7%area under curve (95%CI 0.43–0.70). Conclusions: CSF routine cultures and biochemical studies are not recommended to diagnose VRI. Clinical signs, external ventricular drain manipulation and a drainage insertion over a week justify the routine measurement of proteinorraquia, glycorrhachia and the ratio of glycorrachia/glycemia.

  4. Omission of expected reward sensitizes the brain dopaminergic system of classically conditioned Atlantic salmon

    DEFF Research Database (Denmark)

    Vindas, M.A.; Höglund, Erik; Folkedal, O.

    in fishes. Here we show that the omission of expected reward (OER) leads to increased aggression towards conspecifics in classically conditioned Atlantic salmon (Salmo salar). Furthermore, in response to an acute stressor, OER fish displayed increased dopaminergic (DA) neurotransmission compared to controls....... There was also a general downregulation of dopamine receptor D1 gene expression in the telencephalon of OER groups, which suggests a coping mechanism in response to unbalanced DA metabolism. These results indicate that animals subjected to unpredictable reward conditions develop a senzitation of the DA...

  5. Efficacy of the combined use of a facial cleanser and moisturizers for the care of mild acne patients with sensitive skin. (United States)

    Isoda, Kenichi; Seki, Tsuyoshi; Inoue, Yosuke; Umeda, Koji; Nishizaka, Takahiro; Tanabe, Hisateru; Takagi, Yutaka; Ishida, Koichi; Mizutani, Hitoshi


    Acne is a common skin disease that involves the seborrheic area of the face and results from the obstruction of hair follicles followed by inflammation. Careful face washing helps to improve and prevent acne; however, intensive washing has a risk of inducing skin barrier impairment and dry skin, especially in sensitive skin. We hypothesized that skin care combining mild skin cleansing and intensive moisturizing ("combination skin care") may be effective in the care of acne in subjects with dry skin and/or sensitive skin. We developed a combination skin care with a weakly acidic foaming facial skin cleanser based on a mild detergent, an aqueous lotion with eucalyptus extract and a moisturizing gel containing pseudo-ceramide and eucalyptus extract. To optimize an ideal facial skin care system for mild acne on sensitive skin, we performed a 4-week clinical trial with 29 post-adolescent Japanese women with mild acne with dry and sensitive skin. The acne significantly decreased after this trial accompanied by the improvement of dry skin, a significantly increased endogenous ceramide level in the stratum corneum and an elongated alkyl chain length of the non-hydroxy acyl sphingosine type ceramide. No adverse events due to the test samples were observed. Based on diagnosis by a dermatologist, 97% of the subjects found the combination skin care to be "useful" or "slightly useful". Based on these findings, the combined use of a facial skin cleanser and moisturizers is safe and effective for the care of acne in post-adolescent Japanese women with sensitive skin.

  6. Reasoning Rats: Forward Blocking in Pavlovian Animal Conditioning Is Sensitive to Constraints of Causal Inference (United States)

    Beckers, Tom; Miller, Ralph R.; De Houwer, Jan; Urushihara, Kouji


    Forward blocking is one of the best-documented phenomena in Pavlovian animal conditioning. According to contemporary associative learning theories, forward blocking arises directly from the hardwired basic learning rules that govern the acquisition or expression of associations. Contrary to this view, here the authors demonstrate that blocking in…

  7. Monitoring plant condition and phenology using infrared sensitive consumer grade digital cameras

    NARCIS (Netherlands)

    Nijland, W.; de Jong, R.; de Jong, S.M.; Wulder, M.A.; Bater, C.W.; Coops, N.C.


    Consumer-grade digital cameras are recognized as a cost-effective method of monitoring plant health and phenology. The capacity to use these cameras to produce time series information contributes to a better understanding of relationships between environmental conditions, vegetation health, and prod

  8. Is disgust sensitive to classical conditioning as indexed by facial electromyography and behavioural responses?

    NARCIS (Netherlands)

    Borg, Charmaine; Bosman, Renske C; Engelhard, Iris; Olatunji, Bunmi O; de Jong, Peter J


    Earlier studies provided preliminary support for the role of classical conditioning as a pathway of disgust learning, yet this evidence has been limited to self-report. This study included facial electromyographical (EMG) measurements (corrugator and levator muscles) and a behavioural approach task

  9. [Molecular epidemiologic surveillance and antifungal agent sensitivity of Candida albicans isolated from anesthesia intensive care units]. (United States)

    Gülay, Zeynep; Ergon, Cem; Ozkütük, Aydan; Yücesoy, Mine; Biçmen, Meral


    Patients in intensive care units (ICU) are at risk of nosocomial infections. The incidence of nosocomial fungal infections has increased in parallel with the increase of nosocomial infections. Candida albicans is the most frequent pathogenic species among the fungi. The aim of this study was to make an epidemiological surveillance of C. albicans urine isolates which were isolated from patients who were hospitalized in ICU between June 2000 and October 2001 by antifungal susceptibility testing and Randomly Amplified Polymorphic DNA (RAPD) analysis. For this purpose, 38 C. albicans which were isolated from 29 patients were investigated for amphotericin B and fluconazole susceptibility with the microdilution method. The range of minimal inhibitory concentration (MIC) of amphotericin B was between 0.25-1 microgram/ml and MIC50 value was 0.5 microgram/ml and none of the isolates had high (MIC > 1 microgram/ml) MIC values. The MIC values for fluconazole varied between 0.25-16 micrograms/ml and MIC50 value was 1 microgram/ml. While none of the isolates was resistant to fluconazole, two isolates were detected as dose dependent susceptible. RAPD analysis was performed with two different primers in order to investigate clonal relationship, and 22 patterns were detected with one of the primers and 24 patterns were detected with the other. In conclusion, it is thought that the origin of the C. albicans urine isolates were mostly endogenous but exogenous spread might also be considered as isolates that were clonally related were isolated from different patients at the same time interval.

  10. Plants sensitivity on nickel under different conditions of iron or calcium concentration in the nutrient medium

    Directory of Open Access Journals (Sweden)

    Renata Matraszek


    Full Text Available The sensitivity of six vegetable plants on nickel at early stages of their growth was investigated by index of tolerance. Besides the possibility of nickel fitostabilization by additional application of iron or calcium was tested. The experiment was conducted on Petri dishes. Different concentrations of nickel (0; 0,03; 0,06mM Ni as nickel sulphate, iron (0,05; O,OlmM Fe as Fe2+ citrate and calcium (0,50; 0,75; lmM Ca as calcium carbonate were added. Taking into consideration the sensitivity, investigated vegetables can be ordered in the following way: Cucurbita pepo conv. giromontiina L.>Lactuca sativa L.>Sinapis alba L.>Spinacia oleracea L.=Zea mays var. saccharata Kcke.>Phaseolus vulgaris L. Positive, statistically significant effect ofnickel fitostabilization (0,03 or 0,06mM Ni on elongative growth by the iron application (0,10mM Fe was shown for Zea mays var. saccharata Kcke independently of Ni concentration in the nutrient medium as well as for Sinapis alba L. and Phaseolus vulgaris L. in 0,06mM Ni. Addition as much as 0,75mM Ca in the presence 0,03mM Ni had positive result on Sinapis alba L and Phaseolus vulgaris L. seedlings as well as on Zea mays var. saccharata Kcke and Lactuca sativa L. roots and Cucurbita pepo convar. giromontiina L. shoots. Addition of 0,75mM Ca in the presence 0,06mM Ni promoted elongative growth of Zea mays var. saccharata Kcke seedlings. Application lmM Ca resulted in the promotion of elongative growth of Zea mays var. saccharata Kcke. roots (0,03mM Ni as well as Spinacia oleracea L. roots (0,06mM Ni.

  11. Relationship between continuity of care and adverse outcomes varies by number of chronic conditions among older adults with diabetes

    Directory of Open Access Journals (Sweden)

    Eva H. DuGoff


    Full Text Available Follow us on Twitter Co-Editors-in-Chief Martin Fortin Jane Gunn Stewart W. Mercer Susan Smith Marjan van den Akker Society for Academic Primary Care Journal Help USER You are logged in as... avalster My Profile Log Out JOURNAL CONTENT Search Search Scope Search Browse By Issue By Author By Title By Sections By Identify Types OPEN JOURNAL SYSTEMS FONT SIZE Make font size smallerMake font size defaultMake font size larger INFORMATION For Readers For Authors For Librarians ARTICLE TOOLS Print this article Indexing metadata How to cite item Supplementary files Finding References Email this article Email the author Post a Comment NOTIFICATIONS View (378 new Manage IRCMO NEWS ‘Addressing the global challenge of... Publications on multimorbidity... The CARE Plus study Prevalence of multimorbidity in the... Multimorbidity in adults from a... CURRENT ISSUE Atom logo RSS2 logo RSS1 logo HOSTED BY Part of the PKP Publishing Services Network HOME ABOUT USER HOME SEARCH CURRENT ARCHIVES ANNOUNCEMENTS PUBLISHER AUTHOR GUIDELINES SUBMISSIONS WHY PUBLISH WITH US? Home > Vol 6, No 2 (2016 >\tDuGoff Relationship between continuity of care and adverse outcomes varies by number of chronic conditions among older adults with diabetes Eva H. DuGoff, Karen Bandeen-Roche, Gerard F. Anderson Abstract Background: Continuity of care is a basic tenant of primary care practice. However, the evidence on the importance of continuity of care for older adults with complex conditions is mixed. Objective: To assess the relationship between measurement of continuity of care, number of chronic conditions, and health outcomes. Design: We analyzed data from a cohort of 1,600 US older adults with diabetes and ≥1 other chronic condition in a private Medicare health plan from July 2010 to December 2011. Multivariate regression models were used to examine the association of baseline continuity (the first 6 months and the composite outcome of any emergency room use or inpatient

  12. Medical Underwriting In Long-Term Care Insurance: Market Conditions Limit Options For Higher-Risk Consumers. (United States)

    Cornell, Portia Y; Grabowski, David C; Cohen, Marc; Shi, Xiaomei; Stevenson, David G


    A key feature of private long-term care insurance is that medical underwriters screen out would-be buyers who have health conditions that portend near-term physical or cognitive disability. We applied common underwriting criteria based on data from two long-term care insurers to a nationally representative sample of individuals in the target age range (50-71 years) for long-term care insurance. The screening criteria put upper bounds on the current proportion of Americans who could gain coverage in the individual market without changes to medical underwriting practice. Specifically, our simulations show that in the target age range, approximately 30 percent of those whose wealth meets minimum industry standards for suitability for long-term care insurance would have their application for such insurance rejected at the underwriting stage. Among the general population-without considering financial suitability-we estimated that 40 percent would have their applications rejected. The predicted rejection rates are substantially higher than the rejection rates of about 20-25 percent of applicants in the actual market. In evaluating reforms for long-term care financing and their potential to increase private insurance rates, as well as to reduce financial pressure on public safety-net programs, policy makers need to consider the role of underwriting in the market for long-term care insurance.

  13. A multiplexed microfluidic PCR assay for sensitive and specific point-of-care detection of Chlamydia trachomatis.

    Directory of Open Access Journals (Sweden)

    Deborah Dean

    Full Text Available BACKGROUND: Chlamydia trachomatis (Ct is the most common cause of bacterial sexually transmitted diseases (STD worldwide. While commercial nucleic acid amplification tests (NAAT are available for Ct, none are rapid or inexpensive enough to be used at the point-of-care (POC. Towards the first Ct POC NAAT, we developed a microfluidic assay that simultaneously interrogates nine Ct loci in 20 minutes. METHODOLOGY AND PRINCIPAL FINDINGS: Endocervical samples were selected from 263 women at high risk for Ct STDs (∼35% prevalence. A head-to-head comparison was performed with the Roche-Amplicor NAAT. 129 (49.0% and 88 (33.5% samples were positive by multiplex and Amplicor assays, respectively. Sequencing resolved 71 discrepant samples, confirming 53 of 53 positive multiplex samples and 12 of 18 positive Amplicor samples. The sensitivity and specificity were 91.5% and 100%, and 62.4% and 95.9%, respectively, for multiplex and Amplicor assays. Positive and negative predictive values were 100% and 91%, and 94.1% and 68.6%, respectively. CONCLUSIONS: This is the first rapid multiplex approach to Ct detection, and the assay was also found to be superior to a commercial NAAT. In effect, nine simultaneous reactions significantly increased sensitivity and specificity. Our assay can potentially increase Ct detection in globally diverse clinical settings at the POC.

  14. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly. (United States)


    ... limits for up to a total of 24 hours: (A) 4 hours for adults 18 years of age or older; (B) 2 hours for... meals to each patient that are— (1) Consistent with the patient's plan of care, nutritional needs,...

  15. Applications of Conditional Nonlinear Optimal Perturbation to the Study of the Stability and Sensitivity of the Jovian Atmosphere

    Institute of Scientific and Technical Information of China (English)


    A two-layer quasi-geostrophic model is used to study the stability and sensitivity of motions on small-scale vortices in Jupiter's atmosphere. Conditional nonlinear optimal perturbations (CNOPs) and linear singular vectors (LSVs) are both obtained numerically and compared in this paper. The results show that CNOPs can capture the nonlinear characteristics of motions in small-scale vortices in Jupiter's atmosphere and show great difference from LSVs under the condition that the initial constraint condition is large or the optimization time is not very short or both. Besides, in some basic states, local CNOPs are found.The pattern of LSV is more similar to local CNOP than global CNOP in some cases. The elementary application of the method of CNOP to the Jovian atmosphere helps us to explore the stability of variousscale motions of Jupiter's atmosphere and to compare the stability of motions in Jupiter's atmosphere and Earth's atmosphere further.

  16. In vivo conditions to identify Prkci phosphorylation targets using the analog-sensitive kinase method in zebrafish.

    Directory of Open Access Journals (Sweden)

    Elena Cibrián Uhalte

    Full Text Available Protein kinase C iota is required for various cell biological processes including epithelial tissue polarity and organ morphogenesis. To gain mechanistic insight into different roles of this kinase, it is essential to identify specific substrate proteins in their cellular context. The analog-sensitive kinase method provides a powerful tool for the identification of kinase substrates under in vivo conditions. However, it has remained a major challenge to establish screens based on this method in multicellular model organisms. Here, we report the methodology for in vivo conditions using the analog-sensitive kinase method in a genetically-tractable vertebrate model organism, the zebrafish. With this approach, kinase substrates can uniquely be labeled in the developing zebrafish embryo using bulky ATPγS analogs which results in the thiophosphorylation of substrates. The labeling of kinase substrates with a thiophosphoester epitope differs from phosphoesters that are generated by all other kinases and allows for an enrichment of thiophosphopeptides by immunoaffinity purification. This study provides the foundation for using the analog-sensitive kinase method in the context of complex vertebrate development, physiology, or disease.

  17. Radiation sensitivity of poliovirus, a model for norovirus, inoculated in oyster ( Crassostrea gigas) and culture broth under different conditions (United States)

    Jung, Pil-Mun; Park, Jae Seok; Park, Jin-Gyu; Park, Jae-Nam; Han, In-Jun; Song, Beom-Seok; Choi, Jong-il; Kim, Jae-Hun; Byun, Myung-Woo; Baek, Min; Chung, Young-Jin; Lee, Ju-Woon


    Poliovirus is a recognized surrogate for norovirus, pathogen in water and food, due to the structural and genetic similarity. Although radiation sensitivity of poliovirus in water or media had been reported, there has been no research in food model such as shellfish. In this study, oyster ( Crassostrea gigas) was incubated in artificial seawater contaminated with poliovirus, and thus radiation sensitivity of poliovirus was determined in inoculated oyster. The effects of ionizing radiation on the sensitivity of poliovirus were also evaluated under different conditions such as pH (4-7) and salt concentration (1-15%) in culture broth, and temperature during irradiation. The D10 value of poliovirus in PBS buffer, virus culture broth and oyster was determined to 0.46, 2.84 and 2.94 kGy, respectively. The initial plaque forming unit (PFU) of poliovirus in culture broth was slightly decreased as the decrease of pH and the increase of salt concentration, but radiation sensitivity was not affected by pH and salt contents. However, radiation resistance of poliovirus was increased at frozen state. These results provide the basic information for the inactivation of pathogenic virus in foods by using irradiation.

  18. Radiation sensitivity of poliovirus, a model for norovirus, inoculated in oyster (Crassostrea gigas) and culture broth under different conditions

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Pil-Mun [Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup 580-185 (Korea, Republic of); Park, Jae Seok [Korea Food and Drug Administration, Seoul 122-704 (Korea, Republic of); Park, Jin-Gyu; Park, Jae-Nam; Han, In-Jun; Song, Beom-Seok; Choi, Jong-il; Kim, Jae-Hun; Byun, Myung-Woo [Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup 580-185 (Korea, Republic of); Baek, Min [Atomic Energy Policy Division, Ministry of Education, Science and Technology, Gwacheon 427-715 (Korea, Republic of); Chung, Young-Jin [Department of Food and Nutrition, Chungnam National University, Daejeon 305-764 (Korea, Republic of); Lee, Ju-Woon [Advanced Radiation Technology Institute, Korea Atomic Energy Research Institute, Jeongeup 580-185 (Korea, Republic of)], E-mail:


    Poliovirus is a recognized surrogate for norovirus, pathogen in water and food, due to the structural and genetic similarity. Although radiation sensitivity of poliovirus in water or media had been reported, there has been no research in food model such as shellfish. In this study, oyster (Crassostrea gigas) was incubated in artificial seawater contaminated with poliovirus, and thus radiation sensitivity of poliovirus was determined in inoculated oyster. The effects of ionizing radiation on the sensitivity of poliovirus were also evaluated under different conditions such as pH (4-7) and salt concentration (1-15%) in culture broth, and temperature during irradiation. The D{sub 10} value of poliovirus in PBS buffer, virus culture broth and oyster was determined to 0.46, 2.84 and 2.94 kGy, respectively. The initial plaque forming unit (PFU) of poliovirus in culture broth was slightly decreased as the decrease of pH and the increase of salt concentration, but radiation sensitivity was not affected by pH and salt contents. However, radiation resistance of poliovirus was increased at frozen state. These results provide the basic information for the inactivation of pathogenic virus in foods by using irradiation.

  19. Sensitivity and specificity of a two-question screening tool for depression in a specialist palliative care unit.

    LENUS (Irish Health Repository)

    Payne, Ann


    OBJECTIVES: The primary objective in this study is to determine the sensitivity and specificity of a two-item screening interview for depression versus the formal psychiatric interview, in the setting of a specialist palliative in-patient unit so that we may identify those individuals suffering from depressive disorder and therefore optimise their management in this often-complex population. METHODS: A prospective sample of consecutive admissions (n = 167) consented to partake in the study, and the screening interview was asked separately to the formal psychiatric interview. RESULTS: The two-item questionnaire, achieved a sensitivity of 90.7% (95% CI 76.9-97.0) but a lower specificity of 67.7% (95% CI 58.7-75.7). The false positive rate was 32.3% (95% CI 24.3-41.3), but the false negative rate was found to be a low 9.3% (95% CI 3.0-23.1). A subgroup analysis of individuals with a past experience of depressive illness, (n = 95), revealed that a significant number screened positive for depression by the screening test, 55.2% (16\\/29) compared to those with no background history of depression, 33.3% (22\\/66) (P = 0.045). CONCLUSION: The high sensitivity and low false negative rate of the two-question screening tool will aid health professionals in identifying depression in the in-patient specialist palliative care unit. Individuals, who admit to a previous experience of depressive illness, are more likely to respond positively to the two-item questionnaire than those who report no prior history of depressive illness (P = 0.045).

  20. Validation of a provider self-report inventory for measuring patient-centered cultural sensitivity in health care using a sample of medical students. (United States)

    Mirsu-Paun, Anca; Tucker, Carolyn M; Herman, Keith C; Hernandez, Caridad A


    The paper describes the construction and initial evaluation of the new Tucker-Culturally Sensitive Health Care Inventory (T-CSHCI) Provider Form, which was developed to address the shortcomings of existing similar measures. Two hundred seventeen (217) 3rd and 4th year medical students completed the T-CSHCI-Provider Form. Factor analysis was used to identify non-overlapping items. The final solution produced five factors: patient-centeredness, interpersonal skills, disrespect/disempowerment, competence, and cultural knowledge/responsiveness. The five T-CSHCI-Provider Form factors/subscales proved to be reliable and were associated with related constructs as hypothesized. This study provides initial evidence that the T-CSHCI-Provider Form measures independent dimensions of patient-centered culturally sensitive health care as perceived by medical students. Recommendations for ways in which the T-CSHCI Provider Form can be used to guide culturally sensitive health care training are provided.

  1. Audio-visual speech timing sensitivity is enhanced in cluttered conditions.

    Directory of Open Access Journals (Sweden)

    Warrick Roseboom

    Full Text Available Events encoded in separate sensory modalities, such as audition and vision, can seem to be synchronous across a relatively broad range of physical timing differences. This may suggest that the precision of audio-visual timing judgments is inherently poor. Here we show that this is not necessarily true. We contrast timing sensitivity for isolated streams of audio and visual speech, and for streams of audio and visual speech accompanied by additional, temporally offset, visual speech streams. We find that the precision with which synchronous streams of audio and visual speech are identified is enhanced by the presence of additional streams of asynchronous visual speech. Our data suggest that timing perception is shaped by selective grouping processes, which can result in enhanced precision in temporally cluttered environments. The imprecision suggested by previous studies might therefore be a consequence of examining isolated pairs of audio and visual events. We argue that when an isolated pair of cross-modal events is presented, they tend to group perceptually and to seem synchronous as a consequence. We have revealed greater precision by providing multiple visual signals, possibly allowing a single auditory speech stream to group selectively with the most synchronous visual candidate. The grouping processes we have identified might be important in daily life, such as when we attempt to follow a conversation in a crowded room.

  2. Design and Application of a High Sensitivity Piezoresistive Pressure Sensor for Low Pressure Conditions. (United States)

    Yu, Huiyang; Huang, Jianqiu


    In this paper, a pressure sensor for low pressure detection (0.5 kPa-40 kPa) is proposed. In one structure (No. 1), the silicon membrane is partly etched to form a crossed beam on its top for stress concentration. An aluminum layer is also deposited as part of the beam. Four piezoresistors are fabricated. Two are located at the two ends of the beam. The other two are located at the membrane periphery. Four piezoresistors connect into a Wheatstone bridge. To demonstrate the stress concentrate effect of this structure, two other structures were designed and fabricated. One is a flat membrane structure (No. 2), the other is a structure with the aluminum beam, but without etched silicon (No. 3). The measurement results of these three structures show that the No.1 structure has the highest sensitivity, which is about 3.8 times that of the No. 2 structure and 2.7 times that of the No. 3 structure. They also show that the residual stress in the beam has some backside effect on the sensor performance.

  3. Regionalized care for time-critical conditions: lessons learned from existing networks. (United States)

    Carr, Brendan G; Matthew Edwards, J; Martinez, Ricardo


    The 2010 Academic Emergency Medicine (AEM) consensus conference "Beyond Regionalization" aimed to place the design of a 21st century emergency care delivery system at the center of emergency medicine's (EM's) health policy research agenda. To examine the lessons learned from existing regional systems, consensus conference organizers convened a panel discussion made up of experts from the fields of acute care surgery, interventional cardiology, acute ischemic stroke, cardiac arrest, critical care medicine, pediatric EM, and medical toxicology. The organizers asked that each member provide insight into the barriers that slowed network creation and the solutions that allowed them to overcome barriers. For ST-segment elevation myocardial infarction (STEMI) management, the American Heart Association's (AHA's) Mission: Lifeline aims to increase compliance with existing guidelines through improvements in the chain of survival, including emergency medical services (EMS) protocols. Increasing use of therapeutic hypothermia post-cardiac arrest through a network of hospitals in Virginia has led to dramatic improvements in outcome. A regionalized network of acute stroke management in Cincinnati was discussed, in addition to the effect of pediatric referral centers on pediatric capabilities of surrounding facilities. The growing importance of telemedicine to a variety of emergencies, including trauma and critical care, was presented. Finally, the importance of establishing a robust reimbursement mechanism was illustrated by the threatened closure of poison control centers nationwide. The panel discussion added valuable insight into the possibilities of maximizing patient outcomes through regionalized systems of emergency care. A primary challenge remaining is for EM to help to integrate the existing and developing disease-based systems of care into a more comprehensive emergency care system.

  4. Aerobiological importance and allergic sensitization to Amaranthaceae under arid climate conditions. (United States)

    Elvira-Rendueles, Belén; Zapata, Juan J; Miralles, Juan C; Moreno, José M; García-Sánchez, Antonio; Negral, Luis; Moreno-Grau, Stella


    Species of the Amaranthaceae family are abundant in the Southeast of Spain, one of the driest areas in Europe. The Amaranthaceae include species of interest from the point of view of allergic diseases. With the expansion of aridity, many species belonging to this family will be favoured. The objectives of this study were: first, to define the prevalence of sensitization to Amaranthaceae pollen in allergic patients in the Southeast of Spain; second, to present the aerobiological features of this taxon; and, finally, to demarcate those periods of increased risk of suffering allergic symptoms with the aim of improving the diagnosis and prevention of hay fever. Skin prick tests with extracts of pollen were performed on patients with symptoms of respiratory allergy referred for consultation for the first time in Almería and Murcia. Samples of the atmospheric bioaerosol were taken using a Lanzoni VPPS 2000 volumetric sampler, samples treatment and subsequent counts being carried out according to the methodology approved by the Spanish Aerobiological Network. The statistical significance of the correlation between aerobiological and meteorological data from this arid region in 2010-2014 was determined. The aerobiological study revealed the presence of two distinct peaks responsible for pollen symptoms. The flowering of this taxon is especially noteworthy in the city of Cartagena, where it supposes 94% of the total pollen collected in these periods. This situation converts Amaranthaceae pollen in the second leading cause of hay fever in the Southeast of Spain. With the expansion of aridity, an increase in the presence of these species is expected. Bearing in mind their prevalence in the spring and summer/autumn periods and their extensive presence in the bioaerosol, this makes data from Southeastern Spanish a benchmark with respect to the aerobiology of this type of pollen.

  5. Pavlovian conditioning and cross-sensitization studies raise challenges to the hypothesis that overeating is an addictive behavior. (United States)

    Harb, M R; Almeida, O F X


    Elevated glucocorticoid levels and sign tracking (ST) in Pavlovian conditioning are potential biomarkers of compulsive behaviors such as addiction. As overeating is sometimes viewed as a form of addictive behavior, we hypothesized that murine Pavlovian sign trackers would have a greater propensity to overeat and develop obesity. Using a food reward in the classical conditioning paradigm, we show that ST behavior is a robust conditioned response but not a predictor of eating and growth trajectories in mice, thus challenging the view that the development of obesity and drug addiction depend on identical mechanisms. This interpretation was supported by experiments which showed that overweight mice do not display cross-sensitization to an addictive drug (morphine), and conversely, that overweight morphine-sensitized animals do not overconsume a highly rewarding food. Although the rewarding/motivational effects of both food and drugs of abuse are mediated by similar neurochemical mechanisms, obesity and drug addiction represent a summation of other dysfunctional input and output pathways that lead to the emergence of two distinct disorders, each of which would deserve a specific pharmacotherapeutic approach.

  6. Dynamic response sensitivity of an offshore wind turbine for varying subsoil conditions

    DEFF Research Database (Denmark)

    Damgaard, Mads; Andersen, Lars Vabbersgaard; Ibsen, Lars Bo


    -hydro-elastic simulations are conducted in the nonlinear multi-body code HAWC2. Correlation of wind speeds and waves is derived on basis of wind–wave scatter diagrams from the North Sea. Slight changes of the soil stiffness, the soil damping and the presence of sediment transportation at seabed are shown to be critical...... and damping ratios are random with probability distributions and cannot be fixed on deterministic values due to physical and statistical uncertainties related to the soil properties. In this paper, a comprehensive study is performed on the dynamic response of an offshore wind turbine installed on a monopile....... The aim is to evaluate to what extent a change of the soil properties affects the fatigue loads for parked conditions. Based on consistent lumped-parameter models calibrated to semi-analytical impedance functions of a monopile embedded in a linear viscoelastic soil layer, fully coupled aero...

  7. Behavioural responses to thermal conditions affect seasonal mass change in a heat-sensitive northern ungulate.

    Directory of Open Access Journals (Sweden)

    Floris M van Beest

    Full Text Available BACKGROUND: Empirical tests that link temperature-mediated changes in behaviour (activity and resource selection to individual fitness or condition are currently lacking for endotherms yet may be critical to understanding the effect of climate change on population dynamics. Moose (Alces alces are thought to suffer from heat stress in all seasons so provide a good biological model to test whether exposure to non-optimal ambient temperatures influence seasonal changes in body mass. Seasonal mass change is an important fitness correlate of large herbivores and affects reproductive success of female moose. METHODOLOGY/PRINCIPAL FINDINGS: Using GPS-collared adult female moose from two populations in southern Norway we quantified individual differences in seasonal activity budget and resource selection patterns as a function of seasonal temperatures thought to induce heat stress in moose. Individual body mass was recorded in early and late winter, and autumn to calculate seasonal mass changes (n = 52 over winter, n = 47 over summer. We found large individual differences in temperature-dependent resource selection patterns as well as within and between season variability in thermoregulatory strategies. As expected, individuals using an optimal strategy, selecting young successional forest (foraging habitat at low ambient temperatures and mature coniferous forest (thermal shelter during thermally stressful conditions, lost less mass in winter and gained more mass in summer. CONCLUSIONS/SIGNIFICANCE: This study provides evidence that behavioural responses to temperature have important consequences for seasonal mass change in moose living in the south of their distribution in Norway, and may be a contributing factor to recently observed declines in moose demographic performance. Although the mechanisms that underlie the observed temperature mediated habitat-fitness relationship remain to be tested, physiological state and individual variation in

  8. Enhanced sensitivity and contrast with bimodal atomic force microscopy with small and ultra-small amplitudes in ambient conditions

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Sergio [Departament de Disseny i Programació de Sistemes Electrònics, UPC-Universitat Politècnica de Catalunya Av. Bases, 61, 08242 Manresa (Barcelona) (Spain)


    Here, we introduce bimodal atomic force microscopy operated with sub-nm and ultra-small, i.e., sub-angstrom, first and second mode amplitudes in ambient conditions. We show how the tip can be made to oscillate in the proximity of the surface and in perpetual contact with the adsorbed water layers while the second mode amplitude and phase provide enhanced contrast and sensitivity. Nonlinear and nonmonotonic behavior of the experimental observables is discussed theoretically with a view to high resolution, enhanced contrast, and minimally invasive mapping. Fractions of meV of energy dissipation are shown to provide contrast above the noise level.

  9. Reversal of apomorphine locomotor sensitization by a single post-conditioning trial treatment with a low autoreceptor dose of apomorphine: a memory re-consolidation approach. (United States)

    Carrera, Marinete Pinheiro; Carey, Robert J; Dias, Flávia Regina Cruz; de Matos, Liana Wermelinger


    Sensitization is a common feature of psychostimulants and sensitization effects are generally considered to be linked to the addictive properties of these drugs. We used a conventional paired/unpaired Pavlovian protocol to induce a context specific sensitization to the locomotor stimulant effect of a high dose of apomorphine (2.0mg/kg). Two days following a 5 session sensitization induction phase, a brief 5min non-drug test for conditioning was conducted. Only the paired groups exhibited locomotor stimulant conditioned response effects. Immediately following this brief test for conditioning, the paired and the unpaired groups received injections of 0.05mg/kg apomorphine, 2.0mg/kg apomorphine or vehicle designed to differentially impact memory re-consolidation of the conditioning. Two days later, all groups received a sensitization challenge test with 2.0mg/kg apomorphine. The 2.0mg/kg apomorphine post-trial treatment potentiated sensitization while the 0.05mg/kg eliminated sensitization. These effects were only observed in the paired groups. The activation of dopaminergic systems by the high dose of apomorphine strengthened the drug/environment association whereas the inhibition of dopamine activity by the low auto-receptor dose eliminated this association. The results point to the importance of conditioning to context specific sensitization and targeting memory re-consolidation of conditioning as a paradigm to modify sensitization.

  10. Electricity Bill Savings from Residential Photovoltaic Systems: Sensitivities to Changes in Future Electricity Market Conditions

    Energy Technology Data Exchange (ETDEWEB)

    Darghouth, Naim; Barbose, Galen; Wiser, Ryan


    This scoping study investigates the impact of, and interactions among, three key sources of uncertainty in the future value of bill savings from customer-sited PV, focusing in particular on residential customers. These three sources of uncertainty are: changes to electricity market conditions that would affect retail electricity prices, changes to the types of retail rate structures available to residential customers with PV, and shifts away from standard net-metering toward other compensation mechanisms for residential PV. We investigate the impact of a range of electricity market scenarios on retail electricity prices and rate structures, and the resulting effects on the value of bill savings from PV. The scenarios include various levels of renewable and solar energy deployment, high and low natural gas prices, the possible introduction of carbon pricing, and greater or lesser reliance on utility-scale storage and demand response. We examine the bill savings from PV with time-invariant, flat residential retail rates, as well as with time-varying retail rates, including time-of-use (TOU) rates and real-time pricing (RTP). In addition, we explore a flat rate with increasing-block pricing (IBP). We evaluate the bill savings from PV with net metering, as currently allowed in many states, as well as scenarios with hourly netting, a partial form of net metering. This scoping study is the first known effort to evaluate these types of interactions in a reasonably comprehensive fashion, though by no means have we considered every possible change to electricity market conditions, retail rate structures, or PV compensation mechanisms. It focuses solely on the private value of bill savings for residential PV and does not seek to quantify the broader social or economic cost or value of solar electricity. Our analysis applies assumptions based loosely on California’s electricity market in a future year (2030); however, it is neither intended to forecast California’s future

  11. Short-run Effects of Job Loss on Health Conditions, Health Insurance, and Health Care Utilization


    Jessamyn Schaller; Ann Huff Stevens


    Job loss in the United States is associated with long-term reductions in income and long-term increases in mortality rates. This paper examines the short- to medium-term changes in health, health care access, and health care utilization after job loss that lead to these long-term effects. Using a sample with more than 9800 individual job losses and longitudinal data on a wide variety of health-related measures and outcomes, we show that job loss results in worse self-reported health, includin...

  12. Electricity Bill Savings from Residential Photovoltaic Systems: Sensitivities to Changes in Future Electricity Market Conditions

    Energy Technology Data Exchange (ETDEWEB)

    Darghouth, Naim [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Barbose, Galen [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Wiser, Ryan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division


    Customer-sited photovoltaic (PV) systems in the United States are often compensated at the customer’s underlying retail electricity rate through net metering. Calculations of the customer economics of PV, meanwhile, often assume that retail rate structures and PV compensation mechanisms will not change and that retail electricity prices will increase (or remain constant) over time, thereby also increasing (or keeping constant) the value of bill savings from PV. Given the multitude of potential changes to retail rates and PV compensation mechanisms in the future, however, understanding how such changes might impact the value of bill savings from PV is critical for policymakers, regulators, utilities, the solar industry, and potential PV owners, i.e., any stakeholder interested in understanding uncertainties in and potential changes to the long-term customer economics of PV. This scoping study investigates the impact of, and interactions among, three key sources of uncertainty in the future value of bill savings from customer-sited PV, focusing in particular on residential customers. These three sources of uncertainty are: changes to electricity market conditions that would affect retail electricity prices, changes to the types of retail rate structures available to residential customers with PV, and shifts away from standard net-metering toward other compensation mechanisms for residential PV.

  13. A quantitative sensitivity analysis on the behaviour of common thermal indices under hot and windy conditions in Doha, Qatar (United States)

    Fröhlich, Dominik; Matzarakis, Andreas


    Human thermal perception is best described through thermal indices. The most popular thermal indices applied in human bioclimatology are the perceived temperature (PT), the Universal Thermal Climate Index (UTCI), and the physiologically equivalent temperature (PET). They are analysed focusing on their sensitivity to single meteorological input parameters under the hot and windy meteorological conditions observed in Doha, Qatar. It can be noted, that the results for the three indices are distributed quite differently. Furthermore, they respond quite differently to modifications in the input conditions. All of them show particular limitations and shortcomings that have to be considered and discussed. While the results for PT are unevenly distributed, UTCI shows limitations concerning the input data accepted. PET seems to respond insufficiently to changes in vapour pressure. The indices should therefore be improved to be valid for several kinds of climates.

  14. 42 CFR 485.711 - Condition of participation: Plan of care and physician involvement. (United States)


    ... reviewed by a physician, or by a physical therapist or speech pathologist respectively. (a) Standard... therapist or speech-language pathologist who furnishes the services. (2) The plan of care for physical... in the clinical record. If the patient has an attending physician, the therapist or...

  15. Diagnostic agreement between a primary care physician and a teledermatologist for common dermatological conditions in North India

    Directory of Open Access Journals (Sweden)

    Binod Kumar Patro


    Full Text Available Background: Primary care physicians (PCPs encounter a large number of patients with dermatological diseases. However, delivering appropriate management is a challenge considering the inadequate dermatology training offered during the undergraduate medical curriculum. Teledermatology is the clinical evaluation of skin lesions by dermatologists and allows patients to be diagnosed and treated from a distant site. It is seen as a potential solution to the shortage of specialists and providing equitable service in remote areas. Aim: The study was aimed at estimating the diagnostic agreement of common dermatological conditions between a PCP and a teledermatologist. Materials and Methods: Consecutive patients with dermatological ailments who attended a primary health care clinic were recruited into the study, examined by the PCP and offered a diagnosis. The clinical images and patients′ history were collected and transferred to a dermatologist at a tertiary center who also made a diagnosis. Agreement between diagnosis made by the PCPs and the teledermatologist was measured using kappa (κ statistics. Results: Overall agreement between the diagnoses made by a PCP and the dermatologist was found to be 56%. Poor κ agreement (<0.4 was seen in the diagnosis of psoriasis and eczema. Conclusion: Teledermatology can supplement specialist dermatology service in remote areas. There was poor agreement in the diagnosis of psoriasis, classifying various types of eczematous conditions and fungal infections. Scarce manpower in dermatology at the primary health care level compounded by the burden of skin ailments necessitates training of PCPs in common dermatological conditions.

  16. Bacteriological profile and antibiotic sensitivity pattern of neonatal septicaemia in a rural tertiary care hospital in North India

    Directory of Open Access Journals (Sweden)

    S Thakur


    Full Text Available Background: There is not much published literature on neonatal septicemia available for the Sub-Himalayan region of North India. Hence, we undertook this study to find out the bacteriological profile and antibiotic sensitivity pattern of neonatal septicemia in the neonatal Intensive Care Unit. Material and Methods: Blood cultures were performed for all clinically suspected neonatal septicemia cases for 1-year. Identification of all pathogenic isolates was followed by antibiotic sensitivity testing. Results: We did blood cultures for 450 neonates and 42% were culture positive. Early onset sepsis were 92 (49% and 96 (51% were late onset sepsis. Gram-positive isolates were 60% and 40% were Gram-negative. Staphylococcus aureus (40%, coagulase negative Staphylococcus species (16%, non-fermenter group of organisms (NFGOs (15%, and Klebsiella pneumoniae (10% were the main isolates. Nasal cannula 101 (54%, birth asphyxia 91 (48%, and prematurity 73 (38% were the prominent risk factors associated with septicemia. Gram-positive organisms were highly resistant to penicillin (87% whereas Gram-negative isolates showed high resistance to third generation cephalosporins (53–89% and aminoglycosides (50–67%. The S. aureus isolates were methicillin-resistant in 41% whereas extended spectrum beta lactamase production was seen in 48% Gram-negative isolates.Conclusion: Our study highlights the recent emergence of Gram-positive organisms as predominant cause of neonatal septicemia in this part of Sub-Himalayan region, along with the review of literature which shows similar results from North India and rest of the world too. Though Gram-negative bacteria still remain the main cause of mortality in neonatal septicemia, we want to dispel the common notion among practitioners that they are the predominant isolates in neonatal septicemia.

  17. Critical System Cascading Collapse Assessment for Determining the Sensitive Transmission Lines and Severity of Total Loading Conditions

    Directory of Open Access Journals (Sweden)

    Nur Ashida Salim


    Full Text Available This paper presents a computationally accurate technique used to determine the estimated average probability of a system cascading collapse considering the effect of hidden failure on a protection system. This includes an accurate calculation of the probability of hidden failure as it will give significant effect on the results of the estimated average probability of system cascading collapse. The estimated average probability of a system cascading collapse is then used to determine the severe loading condition contributing to a higher risk of a system cascading collapse. This information is important because it will assist the utility to determine the maximum level of increase in the system loading condition before the occurrence of critical power system cascading collapse. Furthermore, the initial tripping of sensitive transmission line contributing to a critical system cascading collapse can also be determined by using the proposed method. Based on the results obtained from this study, it was found that selecting the accurate probability of hidden failure is very important as it will affect the estimated average probability of a system cascading collapse. Comparative study has been done with other techniques to verify the effectiveness of the proposed method used in the determination of sensitive transmission lines.

  18. On the added value and sensitivity of WRF to driving conditions over CORDEX-Africa domain (United States)

    Lorente-Plazas, Raquel; García-Díez, Markel; Jimenez-Guerrero, Pedro; Fernández, Jesús; Montavez, Juan Pedro


    The assessment of the climate variability over Africa has recently attracted the interest of the regional climate downscaling research community. The main reasons are not only because Africa is a climate change hot-spot, but also due to the low capacity of this region for the adaptation and mitigation under negative impacts and its direct dependency on its socio-economic sustainability of the climate variability. Therefore, improvements in the understanding of the African climate could help the governments in decision-making. Under this umbrella, regional climate models (RCMs) are promising tools to assess the African regional climate. The main advantage of the RCMs, with respect to global reanalysis datasets, is the higher detail provided by the increased resolution which implies a better representation of land-surface interactions and atmospheric processes. However, the confidence on the RCMs strongly depends on the reduction/bounding of uncertainties. One of these sources of uncertainties is associated with the selection of the boundary conditions for driving the regional models. In this work, two identical CORDEX-compliant simulations have been performed over Africa with the unique difference of being driven by two different reanalyses. The reanalyses used were the European Centre for Medium Range Weather Forecasts Interim reanalysis (ERA-I) and the Japanese 25-year reanalysis (JRA-25) by the Japanese Meteorological Service. Both reanalyses have identical temporal resolution (6-hr) but different spatial grid resolution, 0.75 and 1.25 degrees, respectively. The regional model used was the Weather Research and Forecasting Model (WRF). The numerical experiments encompass the period 1989-2010 covering the Africa-CORDEX domain with a 50 km horizontal spatial resolution and 28 vertical levels up to 50 hPa. The WRF simulations are compared between them and against observations. For the mean and maximum temperature the CRU monthly time series (0.25deg) from Climatic

  19. Self-reported gingival conditions and self-care in the oral health of Danish women during pregnancy

    DEFF Research Database (Denmark)

    Christensen, Lisa Bøge; Jeppe-Jensen, Dorte; Petersen, Poul Erik


    OBJECTIVES: The purpose of the present study was to describe the self-assessment of gingival health conditions in pregnant women, their oral hygiene behaviour and dental visiting habits, and to analyse self-care practices of pregnant women in relation to perceived gingival problems. MATERIAL...... AND METHODS: The study group comprised 1935 pregnant women living in two areas of Denmark consecutively recruited from August 1998 to March 1999. The survey data were based on telephone interviews. Questions in the interview concerned general health, lifestyles, socioeconomic conditions, gingival conditions......, oral hygiene and utilisation of dental health services. RESULTS: One-third of the study population perceived signs of gingival inflammation; 5% of the pregnant women assessed their gingiva as poor, while 95% reported good or "normal" gingival condition. Ninety six per cent brushed their teeth at least...


    Directory of Open Access Journals (Sweden)



    Full Text Available Urinary tract infection (UTI includes a spectrum of Asymptomatic Bacteruria (ABU, Cystitis, Prostitis and Pyelonephritis. Except in ABU, UTI is represented by symptomatic disease that warrants antimicrobial therapy. 1 Many of the studies have shown increasing antibiotic resistance to these agents. This study consists of a retrospective observational study of culture and sensitivity of 150 urinary samples, collected from patients who presented with symptoms of UTI, in a tertiary care teaching hospital, Northern Kerala, irrespective of their age and sex for a period of six months from June 2015 to November 2015. These results are then analyzed to find common organisms causing UTI in different age groups in either sex and their respective antibiotic resistance are noted. Out of 150 urinary samples 69.34% were sterile, while 30.66% were culture positive. Among the culture positive patients sex distribution was almost equal, with a slight female predominance, having a contribution of 54.35% females and 45.65% males. The most common organism was found to be E.coli, which contributed more than 50 per cent of total culture positivity (54.35%. Others include Staphylococci, Klebsiella Pnuemoniae, Proteus species, Pseudomonas, Enterococci, Candida Albicans etc. Collateral damage is an ecological adverse effect that resist the use of a highly efficacious drug to be considered as first line agent. Our study shows that drugs causing minimal collateral damages like Nitrofurantoin and Fosfomycin can be used as first line agent for treatment of UTI.

  1. Spectrum of Microbial Flora in Diabetic Foot Ulcer and Its Antibiotic Sensitivity Pattern in Tertiary Care Hospital in Ahmedabad, Gujarat

    Directory of Open Access Journals (Sweden)

    Manisha Jain


    Full Text Available Introduction: A Prospective study “Spectrum of Microbial flora in diabetic foot ulcer and its antibiotic sensitivity pattern” was carried out in a tertiary care hospital, Ahmedabad on 125 patients in which 85 were male patients and 40 were female patients. Material and Methods: Swabs samples were collected from the edge and margins of ulcers and organism were identified by gram staining culture and biochemical reactions. Results: Out of 125 specimens 108 specimens showed growth of organisms. Total 157 aerobic organisms were isolated from culture positive specimens. It represents an average of 1.25 organisms per case. Among these organisms, 130 gram negative and 27 gram positive organisms were isolated. Pseudomonas aeruginosa (30.57% was predominant organism followed by Klebsiella spp. (22.29%. Staphylococcus aureus were 12.74% in which Methicillin resistant S. aureus (MRSA was 55%. Conclusion: incidence of growth was 86.4% in which Pseudomonas aeruginosa (30.57% is most common isolate. Organisms in mixed infections showed multidrug resistance as compared to single isolated strain. Diabetic foot infections are polymicrobial in nature. As the Wagner’s grade increased, the prevalence of isolates also increased. [National J of Med Res 2012; 2(3.000: 354-357

  2. Sensitivity of runoff behaviour of Alpine catchments to system conditions - looking at the current and future situation (United States)

    Meißl, Gertraud; Klebinder, Klaus; Kerl, Florian; Dobler, Christian; Geitner, Clemens; Schöberl, Friedrich; Kohl, Bernhard; Markart, Gerhard; Sotier, Bernadette; Formayer, Herbert; Goler, Robert; Gorgas, Theresa; Bürger, Gerd; Bronstert, Axel


    Alpine settlements are often situated on alluvial fans at the outlet of small catchments. Thus they are - due to the short response time - exposed to a high risk in case of flash floods. Within the project "Sensitivity of the runoff characteristics of small Alpine catchments to climate change" we aim at identifying the critical combinations of event characteristics (intensity and duration of rain) and system conditions (soil moisture, state of vegetation and land use, snow cover) producing flash floods in order to improve the predictability of such events. We have investigated three Alpine catchments in western Austria with different altitudes and precipitation regimes. On the plot scale, field measurements, especially irrigation experiments, revealed that the rainfall-runoff reaction of slopes producing a high or low amount of surface runoff is relatively independent of the actual soil moisture content. However, plots producing a medium amount of surface runoff at dry conditions may generate significantly increased surface runoff volumes at moist conditions. Intensive grazing raises the amount of surface runoff with the duration of pasture season. Event analysis and mapping of the catchment inventories showed that the catchments with low (Ruggbachtal, 400 - 1000 m a.s.l, Vorarlberg) and medium altitude (Brixenbachtal, 800 - 2000 m a.s.l., Tyrol) tend to be sensitive to antecedent precipitation. Due to the high amount of pastured areas, the Brixenbach catchment shows a seasonal variation of runoff behaviour with a maximum of surface runoff in the late summer. The highly situated catchment (Längental, 2000 - 3000 m a.s.l., Tyrol) may show an increased runoff response at rain-on-snow-events. Because of its high portion of rock and talus slopes the runoff reaction of the catchment is quite insensitive to antecedent soil moisture content and grazing intensity. Currently ongoing hydrological modelling will show how seasonal system conditions (duration of snow cover

  3. Behavioral sensitization produced by a single administration of apomorphine: implications for the role of Pavlovian conditioning in the mediation of context-specific sensitization. (United States)

    Bloise, Enrrico; Carey, Robert J; Carrera, Marinete Pinheiro


    The present study examined the minimal number of exposures to the D1/D2 agonist apomorphine capable of producing behavioral sensitization. Rats received one (experiment 1) or two administrations on two successive days (experiment 2) of apomorphine (0.5 and 2.0 mg/kg) paired or unpaired to an open-field environment. After 2 days of drug withdrawal, the rats received a challenge injection with the same dose of apomorphine (sensitization test) and locomotion, rearing and sniffing were measured. The results of the first experiment showed that locomotor sensitization occurred after a single acute exposure to apomorphine and that 0.5 and 2.0 mg/kg treatments were equally effective. This sensitization effect was context-specific and was limited to locomotion. The second experiment revealed a differential dose effect on the sensitization test. Two treatments with 2.0 mg/kg potentiated locomotor sensitization as compared with a single treatment but two treatments with 0.5 mg/kg did not increase the sensitization effect more than the single 0.5 mg/kg treatment. This result indicates an interaction between drug dose and frequency of drug treatment for the induction of apomorphine locomotor sensitization. In that the sensitization effects are considered to be a core contributor to psychostimulant addiction, the present findings are of importance to understanding addiction because they indicate that sensitization processes can be initiated with a single drug experience and amplified with exposure to higher drug dosage levels.

  4. Modeling regional aerosol variability over California and its sensitivity to emissions and long-range transport during the 2010 CalNex and CARES campaigns

    Directory of Open Access Journals (Sweden)

    J. D. Fast


    Full Text Available The performance of the Weather Research and Forecasting regional model with chemistry (WRF-Chem in simulating the spatial and temporal variations in aerosol mass, composition, and size over California is quantified using measurements collected during the California Nexus of Air Quality and Climate Experiment (CalNex and the Carbonaceous Aerosol and Radiative Effects Study (CARES conducted during May and June of 2010. The extensive meteorological, trace gas, and aerosol measurements collected at surface sites and along aircraft and ship transects during CalNex and CARES were combined with operational monitoring network measurements to create a single dataset that was used to evaluate the one configuration of the model. Simulations were performed that examined the sensitivity of regional variations in aerosol concentrations to anthropogenic emissions and to long-range transport of aerosols into the domain obtained from a global model. The configuration of WRF-Chem used in this study is shown to reproduce the overall synoptic conditions, thermally-driven circulations, and boundary layer structure observed in region that controls the transport and mixing of trace gases and aerosols. However, sub-grid scale variability in the meteorology and emissions as well as uncertainties in the treatment of secondary organic aerosol chemistry likely contribute to errors at a primary surface sampling site located at the edge of the Los Angeles basin. Differences among the sensitivity simulations demonstrate that the aerosol layers over the central valley detected by lidar measurements likely resulted from lofting and recirculation of local anthropogenic emissions along the Sierra Nevada. Reducing the default emissions inventory by 50% led to an overall improvement in many simulated trace gases and black carbon aerosol at most sites and along most aircraft flight paths; however, simulated organic aerosol was closer to observed when there were no adjustments to the

  5. A sensitivity analysis of the Children's Treatment Network trial: a randomized controlled trial of integrated services versus usual care for children with special health care needs

    Directory of Open Access Journals (Sweden)

    Ye C


    Full Text Available Chenglin Ye,1,2 Gina Browne,1,3 Joseph Beyene,1 Lehana Thabane1,2 1Department of Clinical Epidemiology and Biostatistics, McMaster University, 2Biostatistcs Unit, St Joseph's Healthcare Hamilton, 3School of Nursing, McMaster University, Hamilton, ON, Canada Background: The value of integrated care through comprehensive, coordinated, and family-centered services has been increasingly recognized for improving health outcomes of children with special health care needs (CSHCN. In a randomized controlled trial (RCT, the integrated care provided through the Children's Treatment Network (CTN was compared with usual care in improving the psychosocial health of target CSHCN. In this paper, we aimed to estimate the effect of CTN care by conducting multiple analyses to handle noncompliance in the trial. Methods: The trial recruited target children in Simcoe County and York Region, ON, Canada. Children were randomized to receive CTN or usual care and were followed for 2 years. The CTN group received integrated services through multiple providers to address their specific needs while the usual care group continued to receive care directed by their parents. The outcome was change in psychosocial quality of life at 2 years. We conducted intention-to-treat, as-treated, per-protocol, and instrumental variable analyses to analyze the outcome. Results: The trial randomized 445 children, with 229 in the intervention group and 216 in the control group. During follow-up, 52% of children in the intervention group did not receive complete CTN care for various reasons. At 2 years, we did not find a significant improvement in psychosocial quality of life among the children receiving CTN care compared with usual care (intention-to-treat mean difference 1.50, 95% confidence interval −1.49 to 4.50; P = 0.32. Other methods of analysis yielded similar results. Conclusion: Although the effect of CTN care was not significant, there was evidence showing benefits of integrated

  6. SU-C-BRE-07: Sensitivity Analysis of the Threshold Energy for the Creation of Strand Breaks and of Single and Double Strand Break Clustering Conditions

    Energy Technology Data Exchange (ETDEWEB)

    Pater, P [I El Naqa, J Seuntjens, McGill University, Montreal, Quebec (Canada)


    Purpose: To analyse the sensitivity of the creation of strand breaks (SB) to the threshold energy (Eth) and thresholding method and to quantify the impact of clustering conditions on single strand break (SSB) and double strand break (DSB) yields. Methods: Monte Carlo simulations using Geant4-DNA were conducted for electron tracks of 280 eV to 220 keV in a geometrical DNA model composed of nucleosomes of 396 phospho-diester groups (PDGs) each. A strand break was created inside a PDG when the sum of all energy deposits (method 1) or energy transfers (method 2) was higher than Eth or when at least one interaction deposited (method 3) or transferred (method 4) an energy higher than Eth. SBs were then clustered into SSBs and DSBs using clustering scoring criteria from the literature and compared to our own. Results: The total number of SBs decreases as Eth is increased. In addition, thresholding on the energy transfers (methods 2 and 4) produces a higher SB count than when thresholding on energy deposits (methods 1 and 3). Method 2 produces a step-like function and should be avoided when attempting to optimize Eth. When SBs are grouped into damage patterns, clustering conditions can underestimated SSBs by up to 18 % and DSBs can be overestimated by up to 12 % compared to our own implementation. Conclusion: We show that two often underreported simulation parameters have a non-negligible effect on overall DNA damage yields. First more SBs are counted when using energy transfers to the PDG rather than energy deposits. Also, SBs grouped according to different clustering conditions can influence reported SSB and DSB by as much as 20%. Careful handling of these parameters is required when trying to compare DNA damage yields from different authors. Research funding from the governments of Canada and Quebec. PP acknowledges partial support by the CREATE Medical Physics Research Training Network grant of the Natural Sciences and Engineering Research Council (Grant number: 432290)

  7. The Relationship Between Sociodemographic Characteristics, Work Conditions, and Level of "Mobbing" of Health Workers in Primary Health Care. (United States)

    Picakciefe, Metin; Acar, Gulcihan; Colak, Zehra; Kilic, Ibrahim


    Mobbing is a type of violence which occurs in workplaces and is classified under the community violence subgroup of interpersonal violence. The aim of this study is to examine health care workers who work in primary health care in the city of Mugla and to determine whether there is a relationship between sociodemographic characteristics, work conditions, and their level of mobbing. A cross-sectional analysis has been conducted in which 130 primary health care workers were selected. Of the 130, 119 health workers participated, yielding a response rate of 91.5%; 83.2% of health workers are female, 42.9% are midwives, 27.7% are nurses, and 14.3% are doctors. In all, 31.1% of health workers have faced with "mobbing" in the last 1 year, and the frequency of experiencing "mobbing" of those 48.6% of them is 1 to 3 times per year. A total of 70.3% of those who apply "mobbing" are senior health workers, and 91.9% are female. The frequency of encountering with "mobbing" was found significantly in married health workers, in those 16 years and above according to examined total working time, in those who have psychosocial reactions, and in those who have counterproductive behaviors. It has been discovered that primary health care workers have high prevalence of "mobbing" exposure. To avoid "mobbing" at workplace, authorities and responsibilities of all employees have to be clearly determined.

  8. Pairing of Customer’ Satisfaction with Brand Consciousness and Price Sensitivity (A Feminine Study in Pakistan on Beauty Care Products’ selection, Use and Satisfaction

    Directory of Open Access Journals (Sweden)

    Saima Ulfat


    Full Text Available This research study targets the role of brand consciousness and price sensitivity in relation with satisfaction of females with their selected beauty care products. Data is collected from both working and non-working females via quota sampling primarily and convenience sampling as sub sampling. Responses of 108 females are collected via online Survey. In presented model, Satisfaction is appearing as dependent variable whereas Brand Consciousness and Price Sensitivity are appearing as independent variables. Gathered data is analyzed while using Correlation Coefficient and Multiple Linear Regression. Results indicate a strongest relation of brand consciousness and price sensitivity along with satisfaction and females association with their selected beauty care products. Significance of this research is that manufacturing companies can use its results in order to enhance their marketing related efforts regarding this category of their brands especially with the context of Pakistani females.

  9. A situated-Information Motivation Behavioral Skills Model of Care Initiation and Maintenance (sIMB-CIM): an IMB model based approach to understanding and intervening in engagement in care for chronic medical conditions. (United States)

    Rivet Amico, K


    A sizable portion of adults living with chronic medical conditions (CMCs) delay initiation of care or maintain it inconsistently, which has tremendous personal and public costs. However, few explanatory models with high yield for intervention development and implementation have been proposed to date that would help to characterize and support care use for CMCs. A situated Information, Motivation, Behavioral Skills model of Care Initiation and Maintenance (sIMB-CIM) is presented here as an application of the IMB model to medical care use for CMCs. An example of a sIMB model for characterizing and intervening to support maintenance in HIV-care is provided.

  10. Medical Conditions Differentially Affect the Development of IADL Disability: Implications for Medical Care and Research. (United States)

    Furner, Sylvia E.; And Others


    Determined independent effects of nine self-reported medical conditions on the likelihood of developing specific instrumental activities of daily living (IADLs) disabilities at three points in time. Various medical conditions differentially affect each specific IADL disability, and each IADL disability has its own set of predictors, which, in…

  11. Effect of operating conditions in soil aquifer treatment on the removals of pharmaceuticals and personal care products

    Energy Technology Data Exchange (ETDEWEB)

    He, Kai, E-mail:; Echigo, Shinya; Itoh, Sadahiko


    Soil aquifer treatment (SAT) is an alternative advanced treatment for wastewater reclamation, and it has the potential to control micropollutants including pharmaceuticals and personal care products (PPCPs). However, the relationship of operating conditions in SAT and removals of micropollutants was not clear. In this study, the effects of operating conditions on the removals of PPCPs were evaluated by using lab-scale columns and plant pilot-scale reactors under different operating conditions. Firstly, weathered granite soil (WGS), standard sand (SAND) and Toyoura standard sand (TS) have different soil characteristics such as total organic carbon (TOC) and cation exchange capacity (CEC). In the columns with these packing materials, the removals of carboxylic analgesics and antilipidemics were effective regardless packing materials. The removals of antibiotics were more effective in WGS than in TS and SAND, indicating high TOC and CEC enhance the sorption in SAT. Secondly, with the extension of hydraulic retention time (HRT), the removals of sulfamethoxazole, acetaminophen, crotamiton, and antipyrine were improved in WGS columns, and adaptable biodegradation for moderately removable PPCPs was formed. Thirdly, the removal efficiencies of sulfamethoxazole and crotamiton were higher in the WGS column under vadose condition than in the WGS column under saturated condition, because of aerobic condition in WGS column under vadose condition. Though long HRT and vadose condition had positive influence on the removals of several PPCPs such as sulfamethoxazole, WGS column with an HRT of 7 days under saturated condition removed most PPCPs. - Highlights: • Soil organic matter and cation exchange capacity enhanced the removals of antibiotics in SAT. • A hydraulic retention time (HRT) of 7 days was sufficient for the removals of most PPCPs. • The removals of most selected PPCPs were similar under vadose and saturated conditions. • Vadose condition contributed to the

  12. Influence of Mesenchymal Stem Cells Conditioned Media on Proliferation of Urinary Tract Cancer Cell Lines and Their Sensitivity to Ciprofloxacin. (United States)

    Maj, Malgorzata; Bajek, Anna; Nalejska, Ewelina; Porowinska, Dorota; Kloskowski, Tomasz; Gackowska, Lidia; Drewa, Tomasz


    Mesenchymal stem cells (MSCs) are known to interact with cancer cells through direct cell-to-cell contact and secretion of paracrine factors, although their exact influence on tumor progression in vivo remains unclear. To better understand how fetal and adult stem cells affect tumors, we analyzed viability of human renal (786-0) and bladder (T24) carcinoma cell lines cultured in conditioned media harvested from amniotic fluid-derived stem cells (AFSCs) and adipose-derived stem cells (ASCs). Both media reduced metabolic activity of 786-0 cells, however, decreased viability of T24 cells was noted only after incubation with conditioned medium from ASCs. To test the hypothesis that MSCs-secreted factors might be involved in chemoresistance acquisition, we further analyzed influence of mesenchymal stem cell conditioned media (MSC-CM) on cancer cells sensitivity to ciprofloxacin, that is considered as potential candidate agent for urinary tract cancers treatment. Significantly increased resistance to tested drug indicates that MSCs may protect cancer cells from chemotherapy. J. Cell. Biochem. 118: 1361-1368, 2017. © 2016 Wiley Periodicals, Inc.

  13. Validation of the Danish version of the Patient Assessment of Care for Chronic Conditions questionnaire (PACIC)

    DEFF Research Database (Denmark)

    Sokolowski, Ineta; Maindal, Helle Terkildsen; Vedsted, Peter

    18 or more with type1 or type2 diabetes sampled in a national register of people with diabetes. They were sent a Danish version of the PACIC. Main outcome measures: Data quality (mean, median, item response, missing, floor and ceiling effects), internal consistency (Cronbach's alpha and average...... interitem correlation), item-rest correlations. Model fit from confirmatory factor analysis (CFA). Results: We present the psychometric properties of the questionnaire and the first results evaluating chronic care in Danish people with diabetes. Conclusions: The complexity of validation is greater when...

  14. Reforming Management of Behavior Symptoms and Psychiatric Conditions in Long-Term Care Facilities: A Different Perspective. (United States)

    Levenson, Steven A; Desai, Abhilash K


    Despite much attention including national initiatives, concerns remain about the approaches to managing behavior symptoms and psychiatric conditions across all settings, including in long-term care settings such as nursing homes and assisted living facilities. One key reason why problems persist is because most efforts to "reform" and "correct" the situation have failed to explore or address root causes and instead have promoted inadequate piecemeal "solutions." Further improvement requires jumping off the bandwagon and rethinking the entire issue, including recognizing and applying key concepts of clinical reasoning and the care delivery process to every situation. The huge negative impact of cognitive biases and rote approaches on related clinical problem solving and decision making and patient outcomes also must be addressed.

  15. Sensitivities of crop models to extreme weather conditions during flowering period demonstrated for maize and winter wheat in Austria

    DEFF Research Database (Denmark)

    Eitzinger, J; Thaler, S; Schmid, E;


    The objective of the present study was to compare the performance of seven different, widely applied crop models in predicting heat and drought stress effects. The study was part of a recent suite of model inter-comparisons initiated at European level and constitutes a component that has been...... lacking in the analysis of sources of uncertainties in crop models used to study the impacts of climate change. There was a specific focus on the sensitivity of models for winter wheat and maize to extreme weather conditions (heat and drought) during the short but critical period of 2 weeks after...... or minimum tillage. Since no comprehensive field experimental data sets were available, a relative comparison of simulated grain yields and soil moisture contents under defined weather scenarios with modified temperatures and precipitation was performed for a 2-week period after flowering. The results may...

  16. Simulation of re-entry in a piece of myocardial tissue: strong sensitivity to spatial and temporal conditions. (United States)

    Wohlfart, B; Ohlén, G; Karlsson, L


    A simple model for the simulation of re-entrant excitation was created. The model consists of a matrix of 15x15 compartments, where each compartment has its own action potential that depends dynamically on four ion currents (INa, ICa, Ik and Ib) having time and voltage-dependent activation and inactivation kinetics. The compartments were combined with resistors to simulate electrotonic interaction. At short excitation intervals the action potential was shortened in duration, and at even shorter coupling intervals decremental propagation occurred. Re-entry around an obstacle could be elicited in response to a properly timed extra stimulus. A time dependent unidirectional block was made by making some of the action potentials longer in duration. An obstacle was not a necessary substrate for re-entry, but the timing of the extra stimulus was critical. In the presence of an obstacle, the induction of re-entry was critically dependent on the shape of the obstacle. The most important result of the simulations is that the system is highly sensitive to the initial spatial and temporal conditions. These sensitivities are generic features of dynamic systems that are described by non-linear differential equations and are typical for chaotic systems. The system studied shows features associated with deterministic chaos.

  17. Fate of Pharmaceuticals and Personal Care Products (PPCPs) in Saturated Soil Under Various Redox Conditions (United States)

    Dror, I.; Menahem, A.; Berkowitz, B.


    The growing use of PPCPs results in their increasing release to the aquatic environment. Consequently, understanding the fate of PPCPs under environmentally relevant conditions that account for dynamic flow and varying redox states is critical. In this study, the transport of two organometallic PPCPs, Gd-DTPA and Roxarsone (As complex) and their metal salts (Gd(NO3)3, AsNaO2), is investigated. The former is used widely as a contrasting agent for MRI, while the latter is applied extensively as a food additive in the broiler poultry industry. Both of these compounds are excreted from the body, almost unchanged chemically. Gadolinium complexes are not fully eliminated in wastewater treatment and can reach groundwater via irrigation with treated wastewater; Roxarsone can enter groundwater via leaching from manure used as fertilizer. Studies have shown that the transport of PPCPs in groundwater is affected by environmental conditions such as redox states, pH, and soil type. For this study, column experiments using sand or Mediterranean red sandy clay soil were performed under several redox conditions: aerobic, nitrate-reducing, iron-reducing, sulfate-reducing, methanogenic, and very strongly chemical reducing. Batch experiments to determine adsorption isotherms were also performed for the complexes and metal salts. We found that Gd-DTPA transport was affected by the soil type and was not affected by the redox conditions. In contrast, Roxarsone transport was affected mainly by the different redox conditions, showing delayed breakthrough curves as the conditions became more biologically reduced (strong chemical reducing conditions did not affect the transport). We also observed that the metal salts show essentially no transport while the organic complexes display much faster breakthrough. The results suggest that transport of these PPCPs through soil and groundwater is determined by the redox conditions, as well as by soil type and the form of the applied metal (as salt

  18. Rapid and sensitive lentivirus vector-based conditional gene expression assay to monitor and quantify cell fusion activity.

    Directory of Open Access Journals (Sweden)

    Manuel A F V Gonçalves

    Full Text Available Cell-to-cell fusion is involved in multiple fundamental biological processes. Prominent examples include osteoclast and giant cell formation, fertilization and skeletal myogenesis which involve macrophage, sperm-egg and myoblast fusion, respectively. Indeed, the importance of cell fusion is underscored by the wide range of homeostatic as well as pathologic processes in which it plays a key role. Therefore, rapid and sensitive systems to trace and measure cell fusion events in various experimental systems are in demand. Here, we introduce a bipartite cell fusion monitoring system based on a genetic switch responsive to the site-specific recombinase FLP. To allow flexible deployment in both dividing as well as non-dividing cell populations, inducer and reporter modules were incorporated in lentivirus vector particles. Moreover, the recombinase-inducible transcription units were designed in such a way as to minimize basal activity and chromosomal position effects in the "off" and "on" states, respectively. The lentivirus vector-based conditional gene expression assay was validated in primary human mesenchymal stem cells and in a differentiation model based on muscle progenitor cells from a Duchenne muscular dystrophy patient using reporter genes compatible with live- and single-cell imaging and with whole population measurements. Using the skeletal muscle cell differentiation model, we showed that the new assay displays low background activity, a 2-log dynamic range, high sensitivity and is amenable to the investigation of cell fusion kinetics. The utility of the bipartite cell fusion monitoring system was underscored by a study on the impact of drug- and RNAi-mediated p38 MAPK inhibition on human myocyte differentiation. Finally, building on the capacity of lentivirus vectors to readily generate transgenic animals the present FLP-inducible system should be adaptable, alone or together with Cre/loxP-based assays, to cell lineage tracing and

  19. Radiation-sensitive severe combined immunodeficiency: The arguments for and against conditioning before hematopoietic cell transplantation--what to do? (United States)

    Cowan, Morton J; Gennery, Andrew R


    Defects in DNA cross-link repair 1C (DCLRE1C), protein kinase DNA activated catalytic polypeptide (PRKDC), ligase 4 (LIG4), NHEJ1, and NBS1 involving the nonhomologous end-joining (NHEJ) DNA repair pathway result in radiation-sensitive severe combined immunodeficiency (SCID). Results of hematopoietic cell transplantation for radiation-sensitive SCID suggest that minimizing exposure to alkylating agents and ionizing radiation is important for optimizing survival and minimizing late effects. However, use of preconditioning with alkylating agents is associated with a greater likelihood of full T- and B-cell reconstitution compared with no conditioning or immunosuppression alone. A reduced-intensity regimen using fludarabine and low-dose cyclophosphamide might be effective for patients with LIG4, NHEJ1, and NBS1 defects, although more data are needed to confirm these findings and characterize late effects. For patients with mutations in DCLRE1C (Artemis-deficient SCID), there is no optimal approach that uses standard dose-alkylating agents without significant late effects. Until nonchemotherapy agents, such as anti-CD45 or anti-CD117, become available, options include minimizing exposure to alkylators, such as single-agent low-dose targeted busulfan, or achieving T-cell reconstitution, followed several years later with a conditioning regimen to restore B-cell immunity. Gene therapy for these disorders will eventually remove the issues of rejection and graft-versus-host disease. Prospective multicenter studies are needed to evaluate these approaches in this rare but highly vulnerable patient population.

  20. Identification of brain nuclei implicated in cocaine-primed reinstatement of conditioned place preference: a behaviour dissociable from sensitization.

    Directory of Open Access Journals (Sweden)

    Robyn Mary Brown

    Full Text Available Relapse prevention represents the primary therapeutic challenge in the treatment of drug addiction. As with humans, drug-seeking behaviour can be precipitated in laboratory animals by exposure to a small dose of the drug (prime. The aim of this study was to identify brain nuclei implicated in the cocaine-primed reinstatement of a conditioned place preference (CPP. Thus, a group of mice were conditioned to cocaine, had this place preference extinguished and were then tested for primed reinstatement of the original place preference. There was no correlation between the extent of drug-seeking upon reinstatement and the extent of behavioural sensitization, the extent of original CPP or the extinction profile of mice, suggesting a dissociation of these components of addictive behaviour with a drug-primed reinstatement. Expression of the protein product of the neuronal activity marker c-fos was assessed in a number of brain regions of mice that exhibited reinstatement (R mice versus those which did not (NR mice. Reinstatement generally conferred greater Fos expression in cortical and limbic structures previously implicated in drug-seeking behaviour, though a number of regions not typically associated with drug-seeking were also activated. In addition, positive correlations were found between neural activation of a number of brain regions and reinstatement behaviour. The most significant result was the activation of the lateral habenula and its positive correlation with reinstatement behaviour. The findings of this study question the relationship between primed reinstatement of a previously extinguished place preference for cocaine and behavioural sensitization. They also implicate activation patterns of discrete brain nuclei as differentiators between reinstating and non-reinstating mice.

  1. A randomized study of telephonic care support in populations at risk for musculoskeletal preference-sensitive surgeries

    Directory of Open Access Journals (Sweden)

    Veroff David R


    Full Text Available Abstract Background The rate of elective surgeries varies dramatically by geography in the United States. For many of these surgeries, there is not clear evidence of their relative merits over alternate treatment choices and there are significant tradeoffs in short- and long-term risks and benefits of selecting one treatment option over another. Conditions and symptoms for which there is this lack of a single clear evidence-based treatment choice present great opportunities for patient and provider collaboration on decision making; back pain and joint osteoarthritis are two such ailments. A number of decision aids are in active use to encourage this shared decision-making process. Decision aids have been assessed in formal studies that demonstrate increases in patient knowledge, increases in patient-provider engagement, and reduction in surgery rates. These studies have not widely demonstrated the added benefit of health coaching in support of shared decision making nor have they commonly provided strong evidence of cost reductions. In order to add to this evidence base, we undertook a comparative study testing the relative impact on health utilization and costs of active outreach through interactive voice response technology to encourage health coaching in support of shared decision making in comparison to mailed outreach or no outreach. This study focused on individuals with back pain or joint pain. Methods We conducted four waves of stratified randomized comparisons for individuals with risk for back, hip, or knee surgery who did not have claims-based evidence of one or more of five chronic conditions and were eligible for population care management services within three large regional health plans in the United States. An interactive voice response (IVR form of outreach that included the capability for individuals to directly connect with health coaches telephonically, known as AutoDialog®, was compared to a control (mailed outreach or

  2. Analysis of ex-vessel melt jet breakup and coolability. Part 1: Sensitivity on model parameters and accident conditions

    Energy Technology Data Exchange (ETDEWEB)

    Moriyama, Kiyofumi; Park, Hyun Sun, E-mail:; Hwang, Byoungcheol; Jung, Woo Hyun


    Highlights: • Application of JASMINE code to melt jet breakup and coolability in APR1400 condition. • Coolability indexes for quasi steady state breakup and cooling process. • Typical case in complete breakup/solidification, film boiling quench not reached. • Significant impact of water depth and melt jet size; weak impact of model parameters. - Abstract: The breakup of a melt jet falling in a water pool and the coolability of the melt particles produced by such jet breakup are important phenomena in terms of the mitigation of severe accident consequences in light water reactors, because the molten and relocated core material is the primary heat source that governs the accident progression. We applied a modified version of the fuel–coolant interaction simulation code, JASMINE, developed at Japan Atomic Energy Agency (JAEA) to a plant scale simulation of melt jet breakup and cooling assuming an ex-vessel condition in the APR1400, a Korean advanced pressurized water reactor. Also, we examined the sensitivity on seven model parameters and five initial/boundary condition variables. The results showed that the melt cooling performance of a 6 m deep water pool in the reactor cavity is enough for removing the initial melt enthalpy for solidification, for a melt jet of 0.2 m initial diameter. The impacts of the model parameters were relatively weak and that of some of the initial/boundary condition variables, namely the water depth and melt jet diameter, were very strong. The present model indicated that a significant fraction of the melt jet is not broken up and forms a continuous melt pool on the containment floor in cases with a large melt jet diameter, 0.5 m, or a shallow water pool depth, ≤3 m.

  3. HistoFlex--a microfluidic device providing uniform flow conditions enabling highly sensitive, reproducible and quantitative in situ hybridizations. (United States)

    Søe, Martin Jensen; Okkels, Fridolin; Sabourin, David; Alberti, Massimo; Holmstrøm, Kim; Dufva, Martin


    A microfluidic device (the HistoFlex) designed to perform and monitor molecular biological assays under dynamic flow conditions on microscope slide-substrates, with special emphasis on analyzing histological tissue sections, is presented. Microscope slides were reversibly sealed onto a cast polydimethylsiloxane (PDMS) insert, patterned with distribution channels and reaction chambers. Topology optimization was used to design reaction chambers with uniform flow conditions. The HistoFlex provided uniform hybridization conditions, across the reaction chamber, as determined by hybridization to microscope slides of spotted DNA microarrays when applying probe concentrations generally used in in situ hybridization (ISH) assays. The HistoFlex's novel ability in online monitoring of an in situ hybridization assay was demonstrated using direct fluorescent detection of hybridization to 18S rRNA. Tissue sections were not visually damaged during assaying, which enabled adapting a complete ISH assay for detection of microRNAs (miRNA). The effects of flow based incubations on hybridization, antibody incubation and Tyramide Signal Amplification (TSA) steps were investigated upon adapting the ISH assay for performing in the HistoFlex. The hybridization step was significantly enhanced using flow based incubations due to improved hybridization efficiency. The HistoFlex device enabled a fast miRNA ISH assay (3 hours) which provided higher hybridization signal intensity compared to using conventional techniques (5 h 40 min). We further demonstrate that the improved hybridization efficiency using the HistoFlex permits more complex assays e.g. those comprising sequential hybridization and detection of two miRNAs to be performed with significantly increased sensitivity. The HistoFlex provides a new histological analysis platform that will allow multiple and sequential assays to be performed under their individual optimum assay conditions. Images can subsequently be recorded either in

  4. Lessons from community mental health to drive implementation in health care systems for people with long-term conditions. (United States)

    Tansella, Michele; Thornicroft, Graham; Lempp, Heidi


    This paper aims to identify which lessons learned from the evidence and the experiences accruing from the transformation in mental health services in recent decades may have relevance for the future development of healthcare for people with long-term physical conditions. First, nine principles are discussed which we first identified to guide mental health service organisation, and all of which can be potentially applied to long term care as well (autonomy, continuity, effectiveness, accessibility, comprehensiveness, equity, accountability, co-ordination, and efficiency). Second, we have outlined innovative operational aspects of service user participation, many of which were first initiated and consolidated in the mental health field, and some of which are now also being implemented in long term care (including case management, and crisis plans). We conclude that long term conditions, whether mental or physical, deserve a long-term commitment from the relevant health services, and indeed where continuity and co-ordination are properly funded implemented, this can ensure that the symptomatic course is more stable, quality of life is enhanced, and the clinical outcomes are more favourable. Innovations such as self-management for long-term conditions (intended to promote autonomy and empowerment) need to be subjected to the same level of rigorous scientific scrutiny as any other treatment or service interventions.

  5. Improving Deployment-Related Primary Care Provider Assessments of PTSD and Mental Health Conditions (United States)


    2900 is taken  verbatim  from the well‐validated  Primary Care PTSD Screen (PC‐PTSD) (see Prins & Oimette, 2004). Any study that conducted a  Annual...wording is  verbatim , although the  Annual Report: Contract # W81XWH‐09‐2‐0172    62    PDHRA employs a unique scoring algorithm. Outside of PDHRA...preparing combatants for their role in  theatre  which may influence an  individual’s risk of PTSD.   The review by Keane (2006) also found social support

  6. VitruCare: Using digital health to overcome the bounded willpower of patients with long term conditions

    Directory of Open Access Journals (Sweden)

    Carolyn Louise Wilson


    Full Text Available Background: Long term conditions affect 40% of the UK population whilst utilising 70% of the health and social care funding. Digital health has emerged as a solution, to aid patients in self-managing their health and alter unhealthy behaviours. However, for digital health to be effective, the field must have an understanding of what hinders or motivates patient behaviour change. Behavioural economics, as a combination of psychology and economics, can provide this knowledge with relevant concepts, biases and heuristics. One such concept is bounded willpower, which explains why people struggle to make decisions based on their long term interests but are more susceptible to short-term benefits or costs. Aims: The aim of this research is to explore the concept of bounded willpower in relation to digital health within the UK. The focus is primarily on the product VitruCare and its effectiveness at overcoming the bounded willpower of patients with long term conditions. Method: VitruCare used feedback, commitment contracts and channel factors to help overcome bounded willpower in an intervention on 144 patients in the Bradford region who were suffering from hypertension. Quantitative variables of patients’ weight, blood pressure, GP attendances, A&E attendances, acute admissions and outpatient visits were recorded before and after usage. A paired samples t-test was used to indicate significant differences in these two conditions. Results: Results indicated significant improvements in weight (t = 7.377, p = 0.000, systolic (t = 6.743, p = 0.000 and diastolic (t = 11.936, p = 0.000 blood pressure, alongside a significant reduction in GP practice visits (t = 12.643, p = 0.000 and outpatient visits (t = 5.951, p = 0.000. There were no significant differences in A&E attendances (t = 1.440, p = 0.152 and acute admissions (t = 1.029, p = 0.305. Conclusions: VitruCare's understanding of behavioural economics and the potential psychological pitfalls in the

  7. Teams and working conditions in mobile pre-hospital care services: an integrative review



    Study to identify, analyze and summarize the findings available in the literature on the composition of teams and working conditions in Mobile  Pre-Hospital Care Services  (PHC).  Integrative review to search the Base  de Dados  de  Enfermagem [Nursing Database] (BDEnf), the Cumulative  Index  to  Nursing  and  Allied  Health  Literature (CINAHL),  the Latin American and Caribbean Health Sciences Literature (LILACS), PubMed,  SCOPUS,  Web  of  Science and the portal of journals from the Scien...

  8. Chloride transport and its sensitivities to different boundary conditions in reclaimed soil solutions filled with fly ash

    Institute of Scientific and Technical Information of China (English)

    Xiao-Yang CHEN; Jia-Ping YAN; Shi-Wen ZHANG


    Chloride ion transport in reclaimed soil solutions filled with fly ash (FA) was investigated by measuring the hydraulic parameters (i.e.water retention curves and hydraulic conductivity) of three substrates,namely GSL,GFA,and CFA.Similar simulations were carried out under certain weather conditions.The different boundary conditions of chloride transport were also discussed from FA texture,cover soil thickness,groundwater table level,and initial chloride concentration.Furthcrmore,the sensitivities of chloride ions to these effect factors were analyzed.The results show that the different top soil thickness and initial chloride concentration have no effect on salinity of topsoil solution in the monitoring points,but they can clearly change the chloride concentration of FA layers.The sensibilities from top soil thickness and initial chloride content are exceedingly weak to the salinity balance based on two dimensions of the time and concentration.While the different FA texture and groundwater table not only affect the salinity equilibrium process of the whole reclaimed soil profile,but also change its balance state.Generally,coarse FA particles and high groundwater table can defer the salinity balance process of the reclaimed soil solution,and they also increase the chloride concentration of FA layer solutions,and even topsoil ones.

  9. Carbon nanotubes on fluorine-doped tin oxide for fabrication of dye-sensitized solar cells at low temperature condition. (United States)

    Nath, Narayan Chandra Deb; Ahammad, A J Saleh; Sarker, Subrata; Rahman, M Mahbubur; Lim, Sung-Su; Choi, Won-Youl; Lee, Jae-Joon


    The multi-walled carbon nanotubes (MWCNTs), electrophoretically deposited on fluorine-doped tin oxide (FTO), were employed as charge-collecting channels in the TiO2 photoelectrode of dye-sensitized solar cells (DSSCs) fabricated at 200 degrees C. The CNT-networks at the conducting substrate increased the charge collection efficiency of the porous TiO2 film, while the short circuit current increased up to ca. 43% under optimized condition. However, the significant decrease in the open-circuit voltage (Voc) up to ca. 132 mV resulted in the failure of the overall cell efficiency improvement. Findings reveal that the transfer process for the back electron is mainly responsible for the significant Voc drop when the MWCNTs were deposited at the electron-collecting substrate of the photoelectrode. The study demonstrates that electrophoretic deposition of MWCNTs on charge collecting substrate would be applicable to introduce an effective charge-collecting channel for the fabrication of flexible DSSCs under low temperature sintering condition.

  10. conditions

    Directory of Open Access Journals (Sweden)

    M. Venkatesulu


    Full Text Available Solutions of initial value problems associated with a pair of ordinary differential systems (L1,L2 defined on two adjacent intervals I1 and I2 and satisfying certain interface-spatial conditions at the common end (interface point are studied.

  11. TRAK ontology: defining standard care for the rehabilitation of knee conditions. (United States)

    Button, Kate; van Deursen, Robert W; Soldatova, Larisa; Spasić, Irena


    In this paper we discuss the design and development of TRAK (Taxonomy for RehAbilitation of Knee conditions), an ontology that formally models information relevant for the rehabilitation of knee conditions. TRAK provides the framework that can be used to collect coded data in sufficient detail to support epidemiologic studies so that the most effective treatment components can be identified, new interventions developed and the quality of future randomized control trials improved to incorporate a control intervention that is well defined and reflects clinical practice. TRAK follows design principles recommended by the Open Biomedical Ontologies (OBO) Foundry. TRAK uses the Basic Formal Ontology (BFO) as the upper-level ontology and refers to other relevant ontologies such as Information Artifact Ontology (IAO), Ontology for General Medical Science (OGMS) and Phenotype And Trait Ontology (PATO). TRAK is orthogonal to other bio-ontologies and represents domain-specific knowledge about treatments and modalities used in rehabilitation of knee conditions. Definitions of typical exercises used as treatment modalities are supported with appropriate illustrations, which can be viewed in the OBO-Edit ontology editor. The vast majority of other classes in TRAK are cross-referenced to the Unified Medical Language System (UMLS) to facilitate future integration with other terminological sources. TRAK is implemented in OBO, a format widely used by the OBO community. TRAK is available for download from In addition, its public release can be accessed through BioPortal, where it can be browsed, searched and visualized.

  12. Burnout: Interpreting the perception of Iranian primary rural health care providers from working and organizational conditions

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    Mahrokh Keshvari


    Results: During the content analysis process, six themes were obtained; "instability and frequent changes", "involved in laws and regulations", "pressure and stress due to unbalanced workload and manpower", "helplessness in performing the tasks and duties", "sense of identity threat and low self-concept", and "deprivation of professional development". The mentioned themes indicate a main and more important theme called "burnout". Conclusions: Health services providers in the rural health centers are working in stressful and challenging work conditions and are suffered from deprivation of something for which are responsible to the community.

  13. Visual acuity of fly photoreceptors in natural conditions - dependence on UV sensitizing pigment and light-controlling pupil

    NARCIS (Netherlands)

    Stavenga, DG


    The effect of the UV-absorbing sensitizing pigment fly photoreceptors on absolute, spectral and angular sensitivity was investigated with a wave-optics model for the facet lens-rhabdomere system. When sky light was used as a UV-rich light source, one sensitizing pigment molecule per rhodopsin increa

  14. Parameterization of gaseous dry deposition in atmospheric chemistry models: Sensitivity to aerodynamic resistance formulations under statically stable conditions (United States)

    Toyota, Kenjiro; Dastoor, Ashu P.; Ryzhkov, Andrei


    Turbulence controls the vertical transfer of momentum, heat and trace constituents in the atmospheric boundary layer. In the lowest 10% of this layer lies the surface boundary layer (SBL) where the vertical fluxes of transferred quantities have been successfully parameterized using the Monin-Obukhov similarity theory in weather forecast, climate and atmospheric chemistry models. However, there is a large degree of empiricism in the stability-correction parameterizations used to formulate eddy diffusivity and aerodynamic resistance particularly under strongly stable ambient conditions. Although the influence of uncertainties in stability-correction parameterizations on eddy diffusivity is actively studied in boundary-layer meteorological modeling, its impact on dry deposition in atmospheric chemistry modeling is not well characterized. In this study, we address this gap by providing the mathematical basis for the relationship between the formulations of vertical surface flux used in meteorological and atmospheric chemistry modeling communities, and by examining the sensitivity of the modeled dry deposition velocities in statically stable SBL to the choice of stability-correction parameterizations used in three operational and/or research environmental models (GEM/GEM-MACH, ECMWF IFS and CMAQ-MM5). Aerodynamic resistances (ra) calculated by the three sets of parameterizations are notably different from each other and are also different from those calculated by a "z-less" scaling formulation under strongly stable conditions (the bulk Richardson number > 0.2). Furthermore, we show that many atmospheric chemistry models calculate ra using formulations which are inconsistent with the derivation of micro-meteorological parameters. Finally, practical implications of the differences in stability-correction algorithms are discussed for the computations of dry deposition velocities of SO2, O3 and reactive bromine compounds for specific cases of stable SBL.

  15. Consistent static and small-signal physics-based modeling of dye-sensitized solar cells under different illumination conditions. (United States)

    Cappelluti, Federica; Ma, Shuai; Pugliese, Diego; Sacco, Adriano; Lamberti, Andrea; Ghione, Giovanni; Tresso, Elena


    A numerical device-level model of dye-sensitized solar cells (DSCs) is presented, which self-consistently couples a physics-based description of the photoactive layer with a compact circuit-level description of the passive parts of the cell. The opto-electronic model of the nanoporous dyed film includes a detailed description of photogeneration and trap-limited kinetics, and a phenomenological description of nonlinear recombination. Numerical simulations of the dynamic small-signal behavior of DSCs, accounting for trapping and nonlinear recombination mechanisms, are reported for the first time and validated against experiments. The model is applied to build a consistent picture of the static and dynamic small-signal performance of nanocrystalline TiO2-based DSCs under different incident illumination intensity and direction, analyzed in terms of current-voltage characteristic, Incident Photon to Current Efficiency, and Electrochemical Impedance Spectroscopy. This is achieved with a reliable extraction and validation of a unique set of model parameters against a large enough set of experimental data. Such a complete and validated description allows us to gain a detailed view of the cell collection efficiency dependence on different operating conditions. In particular, based on dynamic numerical simulations, we provide for the first time a sound support to the interpretation of the diffusion length, in the presence of nonlinear recombination and non-uniform electron density distribution, as derived from small-signal characterization techniques and clarify its correlation with different estimation methods based on spectral measurements.

  16. Effects of annealing conditions on the photoelectrochemical properties of dye-sensitized solar cells made with ZnO nanoparticles

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Lanlan; Li, Renjie; Fan, Ke [College of Chemistry and Molecular Science, Wuhan University, Wuhan 430072 (China); Peng, Tianyou [College of Chemistry and Molecular Science, Wuhan University, Wuhan 430072 (China); State Key Laboratory of Rare Earth Materials Chemistry and Applications, Peking University, Beijing 100871 (China)


    Dye-sensitized solar cells (DSSCs) were fabricated by using porous ZnO electrodes derived from home-made ZnO nanoparticles. Electrochemical impedance spectra and open-circuit photovoltage decay curves measurements were performed to investigate the photoelectrochemical characteristics of ZnO films annealed at different temperatures. The experimental results indicate that the effects of the bulk traps and the surface states within the ZnO films on the recombination processes of the photoinjected electrons in DSSCs depend on the annealing temperature. The DSSC based on the ZnO electrode annealed at 400 C exhibits an optimal energy conversion efficiency of 3.92% under the illumination of one sun simulated sunlight because the farthest decrease in the effects of both bulk traps and surface states at this film can maintain a lower charge recombination probability. This result indicates that the ZnO film electrode has promising application in the field of DSSCs, and the optimization of porous film fabrication condition is efficient for the improvement of ZnO-based DSSC's performances. (author)

  17. Patient Experiences, Emotions and Reasons for Frequently using Emergency Health Care for Long-Term Conditions: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Aggeliki Ninou


    Full Text Available 1.1.Background:Chronic illness is associated with increased health service utilisation including frequent use of the emergency department (ED. 1.2.Objectives: In a qualitative study, we aimed to address the reasons for which patients with long-term conditions (LTCs seek frequently urgent or unscheduled care in the ED. 1.3.Methods:Semi-structured interviews were conducted with 35 patients with diabetes, COPD, and rheumatological disorders attending the ED (23 frequent and 12 non-frequent users. Themes concerning the meaning attributed to the symptom, previous ED experiences and expectations, emotional state, emotional responses during the ED visit, illness perceptions, and accessibility to ED and health care servicessatisfaction were examined. Analysis was carried out using content analysis method. 1.4.Results:Previous negative ED experiences and associated emotions were mainly the case for frequent users; frustration of the patient’s needs, devaluation of the patient’s urgent condition and inadequate information provision were underlying their accounts. Elements of poor clinical communication between the patient and the healthcare providers appeared to mediate the emotional state and whole quality of the service provided only for frequent users, especially for those who reported exhaustion related to the chronicity of the illness. 1.5.Conclusion:Frequent ED use by people with LTCs seems to be associated with negative emotions and unmet patients’ needs to experience a trustful environment and feel safe about his health condition. Improving the clinical communication between the patient and the healthcare providers in the ED and fulfilling the patients’ emotional unmet needs may prove effective in reducing urgent healthcare use by people with LTCs.

  18. Serious Mental Illness and Risk for Hospitalizations and Rehospitalizations for Ambulatory Care-sensitive Conditions in Denmark:

    DEFF Research Database (Denmark)

    Davydow, Dimitry; Ribe, Anette Riisgaard; Pedersen, Henrik Søndergaard;


    Antallet af akutte indlæggelser for kroniske sygdomme har i de senere år været stigende i den vestlige verden. De mange indlæggelser har medført øgede udgifter i sundhedsvæsenet, selvom nogle af disse indlæggelser potentielt kunne være undgået med forebyggelse og behandling i det nære sundhedsvæs...

  19. A critical insight into the development pipeline of microfluidic immunoassay devices for the sensitive quantitation of protein biomarkers at the point of care. (United States)

    Barbosa, Ana I; Reis, Nuno M


    The latest clinical procedures for the timely and cost-effective diagnosis of chronic and acute clinical conditions, such as cardiovascular diseases, cancer, chronic respiratory diseases, diabetes or sepsis (i.e. the biggest causes of death worldwide), involve the quantitation of specific protein biomarkers released into the blood stream or other physiological fluids (e.g. urine or saliva). The clinical thresholds are usually in the femtomolar to picolomar range, and consequently the measurement of these protein biomarkers heavily relies on highly sophisticated, bulky and automated equipment in centralised pathology laboratories. The first microfluidic devices capable of measuring protein biomarkers in miniaturised immunoassays were presented nearly two decades ago and promised to revolutionise point-of-care (POC) testing by offering unmatched sensitivity and automation in a compact POC format; however, the development and adoption of microfluidic protein biomarker tests has fallen behind expectations. This review presents a detailed critical overview into the pipeline of microfluidic devices developed in the period 2005-2016 capable of measuring protein biomarkers from the pM to fM range in formats compatible with POC testing, with a particular focus on the use of affordable microfluidic materials and compact low-cost signal interrogation. The integration of these two important features (essential unique selling points for the successful microfluidic diagnostic products) has been missed in previous review articles and explain the poor adoption of microfluidic technologies in this field. Most current miniaturised devices compromise either on the affordability, compactness and/or performance of the test, making current tests unsuitable for the POC measurement of protein biomarkers. Seven core technical areas, including (i) the selected strategy for antibody immobilisation, (ii) the surface area and surface-area-to-volume ratio, (iii) surface passivation, (iv) the

  20. Patient education, nudge, and manipulation: defining the ethical conditions of the person-centered model of care

    Directory of Open Access Journals (Sweden)

    Reach G


    Full Text Available Gérard Reach1,2 1Department of Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital AP-HP, 2EA 3412, Centre de Recherche en Nutrition Humaine Ile-de-France (CRNH-IDF, Paris 13 University, Sorbonne Paris Cité, Bobigny, France Abstract: Patient education (PE is expected to help patients with a chronic disease to manage their lives and give them the possibility of adopting, in an appropriate manner, beneficial changes in health behaviors that are prescribed by their physicians. It is aimed at delineating, agreeing on, and implementing a patient’s personal action plan and is therefore an essential constituent of the person-centered model of care. The aim of this article is to examine the idea that PE may sometimes be a manipulation that is organized for the good of patients in a paternalistic framework. Theoretically, PE differs from manipulation by addressing the reflective intelligence of patients in full light and helping them make autonomous choices. In this article, we examined some analogies between PE and nudge (ie, techniques used to push people to make good choices by organizing their environment. This analysis suggests that PE is not always as transparent and reflective as it is supposed to be and that unmasking these issues may be useful for improving the ethical quality of educational practice that must be performed in a framework of a trusting patient–doctor relationship. Under this condition, PE may sometimes represent a form of persuasion without being accused of patient deception and manipulation: trust is therefore the core of the person-centered model of care. Keywords: patient education, adherence, autonomy, nudge, persuasion, manipulation, deception, trust, person-centered care model, shared decision-making

  1. Antibiotic sensitivity profile of bacterial pathogens in postoperative wound infections at a tertiary care hospital in Gujarat, India

    Directory of Open Access Journals (Sweden)

    Nutanbala N Goswami


    Full Text Available Objective: To find out the most common bacterial pathogens responsible for post-operative wound infection and their antibiotic sensitivity profile. Materials and Methods: This prospective, observational study was carried out in patients of postoperative wound infection. Samples from wound discharge were collected using a sterile swab and studied for identification of isolates by Gram stains and culture growth followed by in vitro antibiotic susceptibility testing performed by disc diffusion method on Mueller Hinton agar. Results: Out of 183 organisms, 126 (68.85% isolated organisms were gram negative. Staphylococcus aureus, 48 (26.23%, was the predominant organism. S. aureus was sensitive to rifampicin (89.58%, levofloxacin (60.42%, and vancomycin (54.17%. Pseudomonas aeruginosa was sensitive to ciprofloxacin (83.78%, gatifloxacin (51.35%, and meropenem (51.35%. Escherichia coli was sensitive to levofloxacin (72.41% and ciprofloxacin (62.07%. Klebsiella pneumoniae was sensitive to ciprofloxacin (63.16%, levofloxacin (63.16%, gatifloxacin (63.16%, and linezolid (56.52%. Proteus mirabilis was sensitive to ciprofloxacin (75% and linezolid (62.50. Proteus vulgaris was sensitive to ampicillin+sulbactam (57.14% followed by levofloxacin (50%. Conclusions: There is an alarming increase of infections caused by antibiotic-resistant bacteria, particularly in the emergence of VRSA/VISA, meropenem, and third generation cephalosporin resistant Pseudomonas aeruginosa. Linezolid showing sensitivity against Gram negative bacteria.

  2. Two-warehouse inventory model for deteriorating items with price-sensitive demand and partially backlogged shortages under inflationary conditions

    Directory of Open Access Journals (Sweden)

    Chandra K. Jaggi


    Full Text Available In today’s competition inherited business world, managing inventory of goods is a major challenge in all the sectors of economy. The demand of an item plays a significant role while managing the stock of goods, as it may depend on several factors viz., inflation, selling price, advertisement, etc. Among these, selling price of an item is a decisive factor for the organization; because in this competitive world of business one is constantly on the lookout for the ways to beat the competition. It is a well-known accepted fact that keeping a reasonable price helps in attracting more customers, which in turn increases the aggregate demand. Thus in order to improve efficiency of business performance organization needs to stock a higher inventory, which needs an additional storage space. Moreover, in today’s unstable global economy there is consequent decline in the real value of money, because the general level of prices of goods and services is rising (i.e., inflation. And since inventories represent a considerable investment for every organization, it is inevitable to consider the effects of inflation and time value of money while determining the optimal inventory policy. With this motivation, this paper is aimed at developing a two-warehouse inventory model for deteriorating items where the demand rate is a decreasing function of the selling price under inflationary conditions. In addition, shortages are allowed and partially backlogged, and the backlogging rate has been considered as an exponentially decreasing function of the waiting time. The model jointly optimizes the initial inventory and the price for the product, so as to maximize the total average profit. Finally, the model is analysed and validated with the help of numerical examples, and a comprehensive sensitivity analysis has been performed which provides some important managerial implications.

  3. Integration of an optical CMOS sensor with a microfluidic channel allows a sensitive readout for biological assays in point-of-care tests. (United States)

    Van Dorst, Bieke; Brivio, Monica; Van Der Sar, Elfried; Blom, Marko; Reuvekamp, Simon; Tanzi, Simone; Groenhuis, Roelf; Adojutelegan, Adewole; Lous, Erik-Jan; Frederix, Filip; Stuyver, Lieven J


    In this manuscript, a microfluidic detection module, which allows a sensitive readout of biological assays in point-of-care (POC) tests, is presented. The proposed detection module consists of a microfluidic flow cell with an integrated Complementary Metal-Oxide-Semiconductor (CMOS)-based single photon counting optical sensor. Due to the integrated sensor-based readout, the detection module could be implemented as the core technology in stand-alone POC tests, for use in mobile or rural settings. The performance of the detection module was demonstrated in three assays: a peptide, a protein and an antibody detection assay. The antibody detection assay with readout in the detection module proved to be 7-fold more sensitive that the traditional colorimetric plate-based ELISA. The protein and peptide assay showed a lower limit of detection (LLOD) of 200 fM and 460 fM respectively. Results demonstrate that the sensitivity of the immunoassays is comparable with lab-based immunoassays and at least equal or better than current mainstream POC devices. This sensitive readout holds the potential to develop POC tests, which are able to detect low concentrations of biomarkers. This will broaden the diagnostic capabilities at the clinician's office and at patient's home, where currently only the less sensitive lateral flow and dipstick POC tests are implemented.

  4. Antibiotic sensitivity pattern of gram negative bacilli isolated from the lower respiratory tract of ventilated patients in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Goel Nidhi


    Full Text Available Background: Lower respiratory tract infections (LRTIs are the most frequent infections among patients in Intensive care units (ICUs. Aims: To know the bacterial profile and determine the antibiotic susceptibility pattern of the lower respiratory tract isolates from patients admitted to the ICU. Settings and Design: Tertiary care hospital, retrospective study. Materials and Methods: Transtracheal or bronchial aspirates from 207 patients admitted to the ICU were cultured, identified, and antibiotic sensitivity was performed by standard methods. Statistical Analysis Used: SPSS software was used for calculation of % R of 95% confidence interval (CI. Results: Of 207 specimens, 144 (69.5% were culture positive and 63 (30.4% showed no growth. From 144 culture positives, 161 isolates were recovered, of which 154 (95.6% were Gram negative bacilli (GNB. In 17 (11.0% patients, two isolates per specimen were recovered. The most common GNB in order of frequency were Pseudomonas aeruginosa (35%, Acinetobacter baumannii (23.6%, and Klebsiella pneumoniae (13.6%. A very high rate of resistance (80-100% was observed among predominant GNB to ciprofloxacin, ceftazidime, co-trimoxazole, and amoxycillin/clavulanic acid combination. Least resistance was noted to meropenem and doxycycline. Conclusion: Nonfermenters are the most common etiological agents of LRTIs in ICU. There is an alarmingly high rate of resistance to cephalosporin and β-lactam-β-lactamase inhibitor group of drugs. Meropenem was found to be the most sensitive drug against all GNB. Acinetobacter and Klebsiella spp. showed good sensitivity to doxycycline.

  5. Life history trade-offs and behavioral sensitivity to testosterone: an experimental test when female aggression and maternal care co-occur.

    Directory of Open Access Journals (Sweden)

    Kimberly A Rosvall

    Full Text Available Research on male animals suggests that the hormone testosterone plays a central role in mediating the trade-off between mating effort and parental effort. However, the direct links between testosterone, intrasexual aggression and parental care are remarkably mixed across species. Previous attempts to reconcile these patterns suggest that selection favors behavioral insensitivity to testosterone when paternal care is essential to reproductive success and when breeding seasons are especially short. Females also secrete testosterone, though the degree to which similar testosterone-mediated trade-offs occur in females is much less clear. Here, I ask whether testosterone mediates trade-offs between aggression and incubation in females, and whether patterns of female sensitivity to testosterone relate to female life history, as is often the case in males. I experimentally elevated testosterone in free-living, incubating female tree swallows (Tachycineta bicolor, a songbird with a short breeding season during which female incubation and intrasexual aggression are both essential to female reproductive success. Testosterone-treated females showed significantly elevated aggression, reduced incubation temperatures, and reduced hatching success, relative to controls. Thus, prolonged testosterone elevation during incubation was detrimental to reproductive success, but females nonetheless showed behavioral sensitivity to testosterone. These findings suggest that the relative importance of both mating effort and parental effort may be central to understanding patterns of behavioral sensitivity in both sexes.

  6. Attitudes of livestock farmers and sensitivity of livestock farming systems to drought conditions in the French Alps

    Directory of Open Access Journals (Sweden)

    Laurent Dobremez


    Full Text Available Livestock farming systems in the French Alps are particularly exposed to the predicted climate change and most of them have already experienced periods of drought since the beginning of the 2000s. Faced with this risk, livestock farmers have put in place a certain number of measures and envisage introducing others in the future. For the present study, surveys were conducted among livestock farmers to identify these measures and analyses were carried out to characterise the attitudes of livestock farmers to drought conditions and to evaluate changes in the sensitivity of their livestock farming systems. With the exception of those farms with extensive irrigated areas, all the farms are seeking solutions to deal with the risks arising from droughts. One solution is to purchase fodder to compensate for the decrease in the harvests that normally provide animal feed in the winter; the amounts purchased vary with the length of wintering required. For the grazing periods, the high mountain livestock breeders and the dairy systems of the Northern Alps rely above all on extending and over-sizing the pasture areas in relation to the needs of the herds. The livestock farms of the Southern Alps also rely on the diversity of vegetation areas and a certain flexibility in the practices used to adapt to conditions experienced during the year. A succession of dry years could result in more radical breakdowns in the livestock systems. It should also be remembered that climate change is only one of the factors influencing the types of changes taking place on farms.Les systèmes d'élevage des Alpes françaises sont fortement exposés au changement climatique annoncé et la plupart subissent déjà des épisodes de sécheresse depuis le début des années 2000. Face à ces aléas, les éleveurs ont mis en œuvre un certain nombre de leviers et envisagent d'en activer d'autres à l'avenir. Des enquêtes en exploitation ont permis d’identifier ces leviers. Leur

  7. Creating a roadmap for delivering gender-sensitive comprehensive care for women veterans: Results of a national expert panel

    NARCIS (Netherlands)

    Kleijn, M.J.J. de; Lagro-Janssen, A.L.M.; Canelo, I.; Yano, E.M.


    BACKGROUND: Women Veterans are a significant minority of users of the VA healthcare system, limiting provider and staff experience meeting their needs in environments historically designed for men. The VA is nonetheless committed to ensuring that women Veterans have access to comprehensive care in e

  8. Patients Suspected of Irritable Bowel Syndrome-Cross-Sectional Study Exploring the Sensitivity of Rome III Criteria in Primary Care

    DEFF Research Database (Denmark)

    Engsbro, Anne Line; Begtrup, Luise Mølenberg; Kjeldsen, Jens;


    The Rome III criteria for irritable bowel syndrome (IBS) are recommended by guidelines to help identify the syndrome. The majority of IBS patients are managed in primary care, where a pragmatic approach to diagnosis is usually adopted, using clinical judgment and knowledge about the patient. Many...

  9. Evaluation of the strengthening of the conditions of voltage security using sensitivity analysis; Avaliacao do reforco das condicoes da seguranca de tensao utilizando a analise de sensibilidade

    Energy Technology Data Exchange (ETDEWEB)

    Rosa, A.L.S.; Costa, V.M. da; Peres, W. [Universidade Federal de Juiz de Fora (UFJF), MG (Brazil). Faculdade de Engenharia], Emails:,,; Prada, R.B. [Pontificia Universidade Catolica (PUC-Rio), Rio de Janeiro, RJ (Brazil). Dept. de Engenharia Eletrica], Email:


    Voltage stability or voltage security analysis has motivated an expressive attention of power systems researchers. In this work, a simple and fast method evaluates voltage security and proposes conditions to improve the loading margin. System analysis is carried out in terms of active power transmission path. Sensitivity analysis provides the most adequate buses to active and reactive power redispatch. A sequential iterative methodology to reinforce system conditions is presented. (author)

  10. Microscopy, culture, and sensitive management of uncomplicated urinary tract infections in adults in the primary care setting. (United States)

    Sivathasan, Niroshan; Rakowski, Krzysztof R


    The high prevalence of urinary tract infections (UTIs) places a significant burden on healthcare systems. Clinicians may over-manage the issue, and there is great variability in practice, with economic- and resource- implications. Up to 40% of patients with a suspected UTI do not have an infection. Using PubMed (Medline) to shortlist relevant papers in English from the last 30 years, and further sub-selection to include only uncomplicated UTIs in adults in primary care, we reviewed the literature pertaining to uncomplicated UTIs, and how it should be managed efficiently in the primary care setting. In general practice, there is no advantage to routinely request microscopy and culture of urine samples in the presence of an appropriate history and urinalysis reagent-strip testing. If antibiotics are required, then a 3-day course shall suffice. Larger epidemiological studies focusing on more susceptible sub-populations may provide better guidance for discriminatory factors to produce an algorithm for treatment.

  11. Point-of-care test for detection of urogenital chlamydia in women shows low sensitivity. A performance evaluation study in two clinics in Suriname.

    Directory of Open Access Journals (Sweden)

    Jannie J van der Helm

    Full Text Available BACKGROUND: In general, point-of-care (POC tests for Chlamydia trachomatis (Ct show disappointing test performance, especially disappointing sensitivity results. However, one study sponsored by the manufacturer (Diagnostics for the Real World reported over 80% sensitivity with their Chlamydia Rapid Test (CRT. We evaluated the performance of this CRT in a non-manufacturer-sponsored trial. METHODS: Between July 2009 and February 2010, we included samples from 912 women in both high- and low-risk clinics for sexually transmitted infections (STIs in Paramaribo, Suriname. Sensitivity, specificity, positive- and negative predictive values (PPV and NPV for CRT compared to NAAT (Aptima, Gen-Probe were determined. Quantitative Ct load and human cell load were determined in all CRT and/or NAAT positive samples. RESULTS: CRT compared to NAAT showed a sensitivity and specificity of 41.2% (95% CI, 31.9%-50.9% and 96.4% (95% CI, 95.0%-97.5%, respectively. PPV and NPV were 59.2% (95% CI, 47.5%-70.1% and 92.9% (95% CI, 91.0%-94.5%, respectively. Quantitative Ct bacterial load was 73 times higher in NAAT-positive/CRT-positive samples compared to NAAT-positive/CRT-negative samples (p<0.001. Human cell load did not differ between true-positive and false-negative CRT results (p = 0.835. Sensitivity of CRT in samples with low Ct load was 12.5% (95% CI, 5.2%-24.2% and in samples with high Ct load 73.5% (95% CI, 59.9%-84.4%. CONCLUSIONS: The sensitivity of CRT for detecting urogenital Ct in this non-manufacturer-sponsored study did not meet the expectations as described previously. The CRT missed samples with a low Ct load. Improved POC are needed as meaningful diagnostic to reduce the disease burden of Ct.


    Directory of Open Access Journals (Sweden)



    Full Text Available In view of the reported emergence of vancomycin resistance in MRSA from the state and the country as a whole we evaluated the pattern of culture and sensitivity on 160 samples from Orthopaedic Department over a period of one year between Nov 2014 and Nov 2015. These belonged to 111 males and 49 females with different aetiologies. Using standard protocols for the culture, 84 (52% samples grew no organisms while Staph aureus was grown in 43 samples (26.8% and gram negative organism in 28 and 5 samples grew mixed organism. Out of these 43 isolates of Staph aureus, MRSA was grown in 32 (74.4% and MSSA in 11 (25.6%. These belonged to 23 (71.8% males and 9 (28.1% females. Majority of MRSA were grown from the patients of acute osteomyelitis and operated fractures (63.3%. Linezolid showed highest sensitivity (100% followed by Vancomycin (96.8%, Clindamycin (37.5%, erythromycin (21%, Amikacin (21%, Levofloxacin (9.3%, cotrimoxazole (9.3% and ciprofloxacin (3.1%. By diffusion method 6 positive cultures depicted doubtful sensitivity pattern for vancomycin (18.75%. However, on further analysis using MIC only one isolate (3.3% showed intermediate resistance to vancomycin; 12 cultures (37.5% were sensitive to vancomycin and linezolid only. The presence of vancomycin resistance calls for a watchful approach towards these infections and an extensive study to better define the problem.

  13. Sensitivity characteristic analysis of adsorbent-mixed carbon nanotube sensors for the detection of SSF₆ decomposition products under PD conditions. (United States)

    Zhang, Xiaoxing; Luo, Chenchen; Tang, Ju


    Sulfur hexafluoride (SF₆) gas decomposition results from the energy produced by partial discharge (PD). The detection of SO₂ and H₂S content, as important characteristic components of the decomposition products, is significant in the determination of the insulation level of SF₆ gas and the inside insulation faults of gas-insulated equipment. A number of gas sensors use carbon nanotubes (CNTs). However, the applications of these sensors are limited by their low intrinsic sensitivity. In this paper, an adsorbent-mixed carbon nanotube gas sensor is proposed to improve the detection of SO₂ and H2S concentrations. The sensitivity of adsorbent-mixed carbon nanotube gas sensors to SO₂ and H₂S at 100 ppm was investigated experimentally. The effect of the mixing ratio on the gas sensitivity characteristic and mechanism of response was also studied. The results show that compared with intrinsic CNTs gas sensors, the gas sensor featuring adsorbent-mixed CNTs has significantly higher sensitivity and responsiveness to SO₂ and H₂S. The resistance-change rate of SO₂ and H₂S increased to 33.7% and 50.9% from 0.96% and 12.9%, respectively. Moreover, the resistance-change rate and gas concentration satisfy a linear relationship. The sensor has good repeatability and stability.

  14. Identifying organisational principles and management practices important to the quality of health care services for chronic conditions

    DEFF Research Database (Denmark)

    Frølich, Anne


    are limited, it is necessary to identify efficient methods to improve the quality of care. Comparing health care systems is a well-known method for identifying new knowledge regarding, for instance, organisational methods and principles. Kaiser Permanente (KP), an integrated health care delivery system...... in the U.S., is recognized as providing high-quality chronic care; to some extent, this is due to KP's implementation of the chronic care model (CCM). This model recommends a range of evidence-based management practices that support the implementation of evidence-based medicine. However, it is not clear...... which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved....

  15. Community acquired pneumonia due to gram negative bacilli and its antibiotic sensitivity pattern in a tertiary care centre


    Ashish Jitendranath; Sudin Koshy


    Background: Gram negative bacteria along with Pseudomonas constitute a significant cause of morbidity and mortality due to pneumonia. As a result it is essential to have appropriate empirical antimicrobial treatment strategies based on the sensitivity pattern of a particular region. In cases with high likelihood of gram negative pneumonia it is essential to start appropriate empirical antibiotics as early as possible to reduce the morbidity and mortality. This study is done to know the antibi...

  16. Community acquired pneumonia due to gram negative bacilli and its antibiotic sensitivity pattern in a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Ashish Jitendranath


    Results: During the study period in 120 cases of pneumonia, there was growth of pathogenic organism. Among the GNB isolated Klebsiella spp was the most common organism isolated at 33.9% followed by Pseudomonas aeruginosa and Escherichia coli at 22.1%. Out of the 53 gram negative samples isolated 4 (7% were Amp C positive, 10 (18.8% were ESBL positive and there was one single case of MBL. The antibiotic sensitivity showed that all the isolates were sensitive to colisitin (100%, while Klebsiella spp, Pseudomonas spp, and Escherichia coli were 100% sensitive to imipenem and meropenem. Resistance pattern of all the isolates showed that the isolates exhibited high resistance to amoxycillin-clavulunate, cefuroxime and cotrimoxazole. While resistance against ceftazidime and cefipime was >40%. On the other hand, isolates showed a low level of resistance against piperacillin tazobactam and cefoperazone-sulbactam. Extremely low level of resistance was observed against imipenem and meropenem, while colistin showed no resistance among the isolates obtained in this study. Conclusions: The study showed that gram-negative bacteria and P. aeruginosa form a relevant part of the microbial pattern of CAP in patients who require hospitalization, particularly those with severe CAP. Initiating antibiotics with gram negative coverage should be considered in this subgroup of patients since initiating the correct antibiotic plays a critical role in the outcome of pneumonia. [Int J Res Med Sci 2016; 4(8.000: 3121-3124

  17. Mapping out structural features in clinical care calling for ethical sensitivity: a theoretical approach to promote ethical competence in healthcare personnel and clinical ethical support services (CESS). (United States)

    Baerøe, Kristine; Norheim, Ole Frithjof


    Clinical ethical support services (CESS) represent a multifaceted field of aims, consultancy models, and methodologies. Nevertheless, the overall aim of CESS can be summed up as contributing to healthcare of high ethical standards by improving ethically competent decision-making in clinical healthcare. In order to support clinical care adequately, CESS must pay systematic attention to all real-life ethical issues, including those which do not fall within the 'favourite' ethical issues of the day. In this paper we attempt to capture a comprehensive overview of categories of ethical tensions in clinical care. We present an analytical exposition of ethical structural features in judgement-based clinical care predicated on the assumption of the moral equality of human beings and the assessment of where healthcare contexts pose a challenge to achieving moral equality. The account and the emerging overview is worked out so that it can be easily contextualized with regards to national healthcare systems and specific branches of healthcare, as well as local healthcare institutions. By considering how the account and the overview can be applied to i) improve the ethical competence of healthcare personnel and consultants by broadening their sensitivity to ethical tensions, ii) identify neglected areas for ethical research, and iii) clarify the ethical responsibility of healthcare institutions' leadership, as well as specifying required institutionalized administration, we conclude that the proposed account should be considered useful for CESS.


    Directory of Open Access Journals (Sweden)



    Full Text Available BACKGROUND Genus Citrobacter is one of the aerobic Gram negative non-sporing bacilli, from the Enterobacteriaceae family. Citrobacter koseri and Citrobacter freundii are the commonest species implicated in infections. It is emerging as an important nosocomial pathogen. It is associated with high mortality and morbidity rate. They are often resistant to routinely used antibiotics. Emerging drug resistance is a therapeutic concern for clinicians worldwide, thus isolation and antibiotic sensitivity of Citrobacter is critically needed. OBJECTIVES Identification of Citrobacter species and antibiotic sensitivity pattern with AmpC and ESBL Detection. METHODS Prospective study was done from June 2014 to March 2015. The samples were collected from patients attending VIMS and RC. The samples were processed and identified by standard protocol. Citrobacter isolates were tested for antibiotic sensitivity by Kirby-Bauer disc diffusion method as per clinical and standard institute guidelines. Detection of AmpC by Cephamycin Hodge test using Cefoxitin 30 μg with ATCC strains of Escherichia coli 25922 was done. ESBL detection was done by Ceftazidime (30 μg and Ceftazidime/clavulanic acid (30 μg/10 μg and Cefotaxime (30 ug Cefotaxime/clavulanic acid (30 ug/10 ug. RESULTS Out of 5695 Gram negative isolates identified, 690 were Citrobacter isolates. Citrobacter koseri 398 (62.5% and Citrobacter freundii 292 (37.5% were the commonest species isolated. The antibiogram as per CLSI Guidelines showed resistance to Fluoroquinolones, Cephalosporins and beta lactamase inhibitors. Carbapenems were found to be sensitive. The resistance to beta lactamase inhibitors increased with the presence of AmpC beta lactamase (76% and ESBL (50%. CONCLUSION Citrobacter species are emerging as an important nosocomial pathogen. Citrobacter koseri and Citrobacter freundii were the commonest species isolated. Antibiogram showing an increase in resistance among the beta lactamase

  19. Preconception Care and Prenatal Care (United States)

    ... at risk for complications? How does stress affect pregnancy? NICHD Research Information Clinical Trials Resources and Publications Preconception Care and Prenatal Care: Condition Information Skip sharing on social media links Share this: Page Content What is preconception ...

  20. Ethylenediurea (EDU) affects the growth of ozone-sensitive and tolerant ash (Fraxinus excelsior) trees under ambient O3 conditions. (United States)

    Paoletti, Elena; Contran, Nicla; Manning, William J; Tagliaferro, Francesco


    Adult ash trees (Fraxinus excelsior L.), known to be sensitive or tolerant to ozone, determined by presence or absence of foliar symptoms in previous years, were treated with ethylenediurea (EDU) at 450 ppm by gravitational trunk infusion over the 2005 growing season (32.5 ppm h AOT40). Tree and shoot growth were recorded in May and September. Leaf area, ectomycorrhizal infection, and leaf and fine root biomass were determined in September. EDU enhanced shoot length and diameter, and the number and area of leaves, in both O3-sensitive and tolerant trees. However, no EDU effects were recorded at the fine root and tree level. Therefore, a potential for EDU protection against O3-caused growth losses of forest trees should be evaluated during longer-term experiments.


    Grishina, N K; Solovieva, N B; Abdulsalamova, Z A


    The article considers issues concerning increasing of quality and accessibility of medical care in Moscow neurological profile included at the expense of wide-spread implementation of specialized day-time hospitals in health care practice. The analysis applied was based on average Moscow indicators of functioning of public health institutions and characteristics of clinical course of diseases of the mentioned profile.

  2. Living in a country with a strong primary care system is beneficial to people with chronic conditions

    NARCIS (Netherlands)

    Hansen, Johan; Groenewegen, Peter P.; Boerma, Wienke G W; Kringos, Dionne S.


    In light of the growing pressure that multiple chronic diseases place on health care systems, we investigated whether strong primary care was associated with improved health outcomes for the chronically ill. We did this by combining country- and individual-level data for the twenty-seven countries o

  3. Living in a country with a strong primary care system is beneficial to people with chronic conditions.

    NARCIS (Netherlands)

    Hansen, J.; Groenewegen, P.P.; Boerma, W.G.W.; Kringos, D.S.


    In light of the growing pressure that multiple chronic diseases place on health care systems, we investigated whether strong primary care was associated with improved health outcomes for the chronically ill. We did this by combining country- and individual-level data for the twenty-seven countries o

  4. Pedagogical Staff in Children's Day Care Centres in Germany--Links between Working Conditions, Job Satisfaction, Commitment and Work-Related Stress (United States)

    Schreyer, Inge; Krause, Martin


    This article investigates links between staff working conditions in children's day care centres ("Kindertageseinrichtungen"--known as "Kitas" in Germany), job satisfaction, commitment and perceived stress at work. Data are based on the nationwide, representative questionnaire survey AQUA ("Arbeitsplatz und Qualität in…

  5. Access to Services, Quality of Care, and Family Impact for Children with Autism, Other Developmental Disabilities, and Other Mental Health Conditions (United States)

    Vohra, Rini; Madhavan, Suresh; Sambamoorthi, Usha; St Peter, Claire


    This cross-sectional study examined perceived access to services, quality of care, and family impact reported by caregivers of children aged 3-17 years with autism spectrum disorders, as compared to caregivers of children with other developmental disabilities and other mental health conditions. The 2009-2010 National Survey of Children with…

  6. Concurrent Medical Conditions and Health Care Use and Needs among Children with Learning and Behavioral Developmental Disabilities, National Health Interview Survey, 2006-2010 (United States)

    Schieve, Laura A.; Gonzalez, Vanessa; Boulet, Sheree L.; Visser, Susanna N.; Rice, Catherine E.; Braun, Kim Van Naarden; Boyle, Coleen A.


    Studies document various associated health risks for children with developmental disabilities (DDs). Further study is needed by disability type. Using the 2006-2010 National Health Interview Surveys, we assessed the prevalence of numerous medical conditions (e.g. asthma, frequent diarrhea/colitis, seizures), health care use measures (e.g. seeing a…

  7. 42 CFR 418.112 - Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/MR. (United States)


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/MR. 418.112 Section 418.112 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM...

  8. Extrinsic High-Effort and Low-Reward Conditions at Work among Institutional Staff Caring for People with Intellectual Disabilities in Taiwan (United States)

    Lee, Tzong-Nan; Lin, Jin-Ding; Yen, Chia-Feng; Loh, Ching-Hui; Hsu, Shang-Wei; Tang, Chi-Chieh; Wu, Jia-Ling; Fang, Wen-Hui; Chu, Cordia M.


    The purposes of the present study were to determine whether extrinsic high-effort/low-reward conditions at work are associated with personal characteristics and the organizational environments. A cross-sectional survey was conducted (76.7% response rate, N = 1243) by recruiting the staff caring for people with intellectual disabilities of Taiwan…

  9. Do we care about sustainability? An analysis of time sensitivity of social preferences under environmental time-persistent effects. (United States)

    Faccioli, Michela; Hanley, Nick; Torres, Cati; Font, Antoni Riera


    Environmental cost-benefit analysis has traditionally assumed that the value of benefits is sensitive to their timing and that outcomes are valued higher, the sooner in time they occur following implementation of a project or policy. Though, this assumption might have important implications especially for the social desirability of interventions aiming at counteracting time-persistent environmental problems, whose impacts occur in the long- and very long-term, respectively involving the present and future generations. This study analyzes the time sensitivity of social preferences for preservation policies of adaptation to climate change stresses. Results show that stated preferences are time insensitive, due to sustainability issues: individuals show insignificant differences in benefits they can experience within their own lifetimes compared to those which occur in the longer term, and which will instead be enjoyed by future generations. Whilst these results may be specific to the experimental design employed here, they do raise interesting questions regarding choices over time-persistent environmental problems, particularly in terms of the desirability of interventions which produce longer-term benefits.


    Directory of Open Access Journals (Sweden)

    Dragoslav KOPACEV


    Full Text Available The term disharmonious is determined against the harmonious development of children. It is stressed that these children, because of the whole bio-psycho-social growth which is at a lower level, very often react with psychical disorders, compared with the children which normally develop and this seems to be not only a serious problem in the diagnostics but also in the performing of the adequate and in due time treatment.Trained by the existing experiences in the work with these children it is indicated that the best differential-diagnostics is performed in conditions of Day hospital where a whole treatment is provided by a professional team. In the treatment in this category of children it is insisted on the respect of the developmental dynamic approach, and for this, the acknowledgments that are given by the neuropsychology are used. The need of early treatment of a child, parents and the closest environment is stressed because if these children are neglected, they show the tendency to organize themselves at their lowest values, they intellectually decline and lead to severe psycho social results .Working with these children in our Day care hospital although we use a great number of therapeutic activities, we put the stress on the application of psycho-motor re education. The use of remedial therapy is the only technical, without including the parents in the working plan, has shown as unadequate. Although there is an intellectual insufficiency, we tend these children to be mentally healthy, if we succeed to achieve bigger harmony in the function of the cognitive, emotional, motor and social aspects of the individual. Providing continuity in the treatment of this category of children, it is insisted to provide the preschool institutions with planned and professional team work. The stress is put on the defectological activity, in a way to prepare the children to enroll in school.

  11. The Psychometric Properties of the Center for Epidemiologic Studies Depression Scale in Chinese Primary Care Patients: Factor Structure, Construct Validity, Reliability, Sensitivity and Responsiveness.

    Directory of Open Access Journals (Sweden)

    Weng Yee Chin

    Full Text Available The Center for Epidemiologic Studies Depression Scale (CES-D is a commonly used instrument to measure depressive symptomatology. Despite this, the evidence for its psychometric properties remains poorly established in Chinese populations. The aim of this study was to validate the use of the CES-D in Chinese primary care patients by examining factor structure, construct validity, reliability, sensitivity and responsiveness.The psychometric properties were assessed amongst a sample of 3686 Chinese adult primary care patients in Hong Kong. Three competing factor structure models were examined using confirmatory factor analysis. The original CES-D four-structure model had adequate fit, however the data was better fit into a bi-factor model. For the internal construct validity, corrected item-total correlations were 0.4 for most items. The convergent validity was assessed by examining the correlations between the CES-D, the Patient Health Questionnaire 9 (PHQ-9 and the Short Form-12 Health Survey (version 2 Mental Component Summary (SF-12 v2 MCS. The CES-D had a strong correlation with the PHQ-9 (coefficient: 0.78 and SF-12 v2 MCS (coefficient: -0.75. Internal consistency was assessed by McDonald's omega hierarchical (ωH. The ωH value for the general depression factor was 0.855. The ωH values for "somatic", "depressed affect", "positive affect" and "interpersonal problems" were 0.434, 0.038, 0.738 and 0.730, respectively. For the two-week test-retest reliability, the intraclass correlation coefficient was 0.91. The CES-D was sensitive in detecting differences between known groups, with the AUC >0.7. Internal responsiveness of the CES-D to detect positive and negative changes was satisfactory (with p value 0.2. The CES-D was externally responsive, with the AUC>0.7.The CES-D appears to be a valid, reliable, sensitive and responsive instrument for screening and monitoring depressive symptoms in adult Chinese primary care patients. In its original

  12. Junction temperature measurements via thermo-sensitive electrical parameters and their application to condition monitoring and active thermal control of power converters

    DEFF Research Database (Denmark)

    Baker, Nick; Liserre, Marco; Dupont, L.


    implementation of active thermal control to reduce losses and increase lifetime can be performed given an accurate knowledge of temperature. Temperature measurements via thermo-sensitive electrical parameters (TSEP) are one way to carry out immediate temperature readings on fully packaged devices. However...... scale implementation of these methods are discussed. Their potential use in the aforementioned goals in condition monitoring and active thermal control is also described....

  13. Identifying organisational principles and management practices important to the quality of health care services for chronic conditions

    DEFF Research Database (Denmark)

    Frølich, Anne


    which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved.......The quality of health care services offered to people suffering from chronic diseases often fails to meet standards in Denmark or internationally. The population consisting of people with chronic diseases is large and accounts for about 70% of total health care expenses. Given that resources...

  14. Development of differential sensitivity of CaOv ovarian adenocarcinoma cells to antitumor agents under conditions of hypoxia. (United States)

    Pavlichenko, O V; Shishkin, A N; Stepanova, E V; Dubovaya, T K; Krasil'nikov, M A


    We studied the role of VEGF signal pathway in autocrine regulation of tumor cell growth and survival under conditions of hypoxia. Hypoxia-resistant CaOv/H substrain with high level of VEGF-A secretion was obtained by long-term culturing of CaOv ovarian adenocarcinoma cells with CoCl2 (hypoxia inductor). VEGF-A directly participates in autocrine regulation of CaOv cell growth, including the maintenance of cell growth under conditions of hypoxia or cytostatic treatment. On the other hand, CaOv/H cells retain high apoptotic potential and are characterized by high expression of p27Kip1 (cyclin-dependent kinase inhibitor), which attests to possible involvement of this inhibitor into the regulation of apoptotic response of cells under conditions of hypoxia.

  15. Spontaneous brain activity in the default mode network is sensitive to different resting-state conditions with limited cognitive load.

    Directory of Open Access Journals (Sweden)

    Chaogan Yan

    Full Text Available BACKGROUND: Recent functional MRI (fMRI studies have demonstrated that there is an intrinsically organized default mode network (DMN in the resting brain, primarily made up of the posterior cingulate cortex (PCC and the medial prefrontal cortex (MPFC. Several previous studies have found that the DMN is minimally disturbed during different resting-state conditions with limited cognitive demand. However, this conclusion was drawn from the visual inspection of the functional connectivity patterns within the DMN and no statistical comparison was performed. METHODOLOGY/PRINCIPAL FINDINGS: Four resting-state fMRI sessions were acquired: 1 eyes-closed (EC (used to generate the DMN mask; 2 EC; 3 eyes-open with no fixation (EO; and 4 eyes-open with a fixation (EO-F. The 2-4 sessions were counterbalanced across participants (n = 20, 10 males. We examined the statistical differences in both functional connectivity and regional amplitude of low frequency fluctuation (ALFF within the DMN among the 2-4 resting-state conditions (i.e., EC, EO, and EO-F. Although the connectivity patterns of the DMN were visually similar across these three different conditions, we observed significantly higher functional connectivity and ALFF in both the EO and the EO-F conditions as compared to the EC condition. In addition, the first and second resting EC conditions showed significant differences within the DMN, suggesting an order effect on the DMN activity. CONCLUSIONS/SIGNIFICANCE: Our findings of the higher DMN connectivity and regional spontaneous activities in the resting state with the eyes open suggest that the participants might have more non-specific or non-goal-directed visual information gathering and evaluation, and mind wandering or daydreaming during the resting state with the eyes open as compared to that with the eyes closed, thus providing insights into the understanding of unconstrained mental activity within the DMN. Our results also suggest that it should

  16. Psychometric properties of the patient assessment of chronic illness care measure: acceptability, reliability and validity in United Kingdom patients with long-term conditions

    Directory of Open Access Journals (Sweden)

    Rick Jo


    Full Text Available Abstract Background The Patient Assessment of Chronic Illness Care (PACIC is a US measure of chronic illness quality of care, based on the influential Chronic Care Model (CCM. It measures a number of aspects of care, including patient activation; delivery system design and decision support; goal setting and tailoring; problem-solving and contextual counselling; follow-up and coordination. Although there is developing evidence of the utility of the scale, there is little evidence about its performance in the United Kingdom (UK. We present preliminary data on the psychometric performance of the PACIC in a large sample of UK patients with long-term conditions. Method We collected PACIC, demographic, clinical and quality of care data from patients with long-term conditions across 38 general practices, as part of a wider longitudinal study. We assess rates of missing data, present descriptive and distributional data, assess internal consistency, and test validity through confirmatory factor analysis, and through associations between PACIC scores, patient characteristics and related measures. Results There was evidence that rates of missing data were high on PACIC (9.6% - 15.9%, and higher than on other scales used in the same survey. Most PACIC sub-scales showed reasonable levels of internal consistency (alpha = 0.68 – 0.94, responses did not demonstrate high skewness levels, and floor effects were more frequent (up to 30.4% on the follow up and co-ordination subscale than ceiling effects (generally Conclusion The importance of improving care for long-term conditions means that the development and validation of measures is a priority. The PACIC scale has demonstrated potential utility in this regard, but further assessment is required to assess low levels of completion of the scale, and to explore the performance of the scale in predicting outcomes and assessing the effects of interventions.

  17. Effectiveness of comprehensive care programs for patients with multiple chronic conditions or frailty: a systematic literature review.

    NARCIS (Netherlands)

    Hopman, P.; Bruijn, S.R. de; Forjaz, M.J.; Rodriguez-Blazquez, C.; Tonnara, G.; Lemmens, L.C.; Onder, G.; Baan, C.A.; Rijken, M.


    Objective: To describe comprehensive care programs targeting multimorbid and/or frail patients and to estimate their effectiveness regarding improvement of patient and caregiver related outcomes, healthcare utilization and costs. Methods: Systematic search in six electronic databases for scientific

  18. QTL mapping of inbreeding-related cold sensitivity and conditional lethality in Drosophila melanogaster

    DEFF Research Database (Denmark)

    Vermeulen, Corneel J.; Bijlsma, R.; Loeschcke, Volker


    Inbreeding depression is a central theme within genetics, and is of specific interest for researchers within evolutionary and conservation genetics and animal and plant breeding. Inbreeding effects are thought to be caused by the joint expression of conditional and unconditional deleterious alleles...

  19. The effect of background hydrometeorological conditions on the sensitivity of evapotranspiration to model parameters: analysis with measurements from an Italian alpine catchment

    Directory of Open Access Journals (Sweden)

    N. Montaldo


    Full Text Available Recent developments have made land-surface models (LSMs more complex through the inclusion of more processes and controlling variables, increasing numbers of parameters and uncertainty in their estimates. To overcome these uncertainties, prior to applying a distributed LSM over the whole Toce basin (Italian Alps, a field campaign was carried out at an experimental plot within the basin before exploring the skill and parameter importance (sensitivity using the TOPLATS model, an existing LSM. In the summer and autumn of 1999, which included both wet (atmosphere controlled and dry (soil controlled periods, actual evapotranspiration estimates were performed using Bowen ratio and, for a short period, eddy correlation methods. Measurements performed with the two methods are in good agreement. The calibrated LSM predicts actual evapotranspiration quite well over the whole observation period. A sensitivity analysis of the evapotranspiration to model parameters was performed through the global multivariate technique during both wet and dry periods of the campaign. This approach studies the influence of each parameter without conditioning on certain values of the other variables. Hence, all parameters are varied simultaneously using, for instance, a uniform sampling strategy through a Monte Carlo simulation framework. The evapotranspiration is highly sensitive to the soil parameters, especially during wet periods. However, the evapotranspiration is also sensitive to some vegetation parameters and, during dry periods, wilting point is the most critical for evapotranspiration predictions. This result confirms the importance of correct representation of vegetation properties which, in water-limited conditions, control evapotranspiration. Keywords: evapotranspiration, sensitivity analysis, land surface model, eddy correlation, Alpine basin

  20. The sensitivity of the Late Saalian (140 ka) and LGM (21 ka) Eurasian ice sheets to sea surface conditions

    Energy Technology Data Exchange (ETDEWEB)

    Colleoni, Florence [Centro Euro-Mediterraneo per i Cambiamenti Climatici, Bologna (Italy); UJF, CNRS, Laboratoire de Glaciologie et Geophysique de l' Environnement, Saint Martin d' Heres Cedex (France); Stockholm University, Department of Geological Sciences, Stockhlom (Sweden); Liakka, Johan [Stockholm University, Department of Meteorology, Stockholm (Sweden); Krinner, Gerhard; Peyaud, Vincent [UJF, CNRS, Laboratoire de Glaciologie et Geophysique de l' Environnement, Saint Martin d' Heres Cedex (France); Jakobsson, Martin [Stockholm University, Department of Geological Sciences, Stockhlom (Sweden); Masina, Simona [Centro Euro-Mediterraneo per i Cambiamenti Climatici, Istituto Nazionale di Geofisica e Vulcanologia, Bologna (Italy)


    This work focuses on the Late Saalian (140 ka) Eurasian ice sheets' surface mass balance (SMB) sensitivity to changes in sea surface temperatures (SST). An Atmospheric General Circulation Model (AGCM), forced with two preexisting Last Glacial Maximum (LGM, 21 ka) SST reconstructions, is used to compute climate at 140 and 21 ka (reference glaciation). Contrary to the LGM, the ablation almost stopped at 140 ka due to the climatic cooling effect from the large ice sheet topography. Late Saalian SST are simulated using an AGCM coupled with a mixed layer ocean. Compared to the LGM, these 140 ka SST show an inter-hemispheric asymmetry caused by the larger ice-albedo feedback, cooling climate. The resulting Late Saalian ice sheet SMB is smaller due to the extensive simulated sea ice reducing the precipitation. In conclusion, SST are important for the stability and growth of the Late Saalian Eurasian ice sheet. (orig.)

  1. Selective conditions for the fabrication of a flexible dye-sensitized solar cell with Ti/TiO 2 photoanode (United States)

    Lin, Lu-Yin; Lee, Chuan-Pei; Vittal, R.; Ho, Kuo-Chuan

    The effects of four factors, i.e., (i) sputter-deposition time of platinum (Pt) film, (ii) sintering temperature of TiO 2-coated Ti foil (Ti/TiO 2), (iii) thickness of Ti foil, and (iv) concentration of iodine are reported for the photovoltaic performance of a back-illuminated flexible dye-sensitized solar cell (DSSC) with Ti foil substrate for the TiO 2 layer. Optimization of these four factors yields a solar-to-electricity conversion efficiency (η) of 5.95%. Transmittance spectra, cyclic voltammetry (CV), electrochemical impedance spectra (EIS), X-ray diffraction (XRD), scanning electron micrographs (SEM), and laser-induced photovoltage transient technique are used to substantiate the explanations.

  2. Assessing the sensitivity of Melanoplus frigidus (Orthoptera:Acrididae) to different weather conditions: A modeling approach focussing on development times

    Institute of Scientific and Technical Information of China (English)

    Oliver-D. Finch; J(o)rg L(o)ffler; Roland Pape


    The temperature and soil moisture conditions as well as vegetation patterns were studied to describe the habitat and to model the life cycle of Melanoplusfrigidus, a true alpine grasshopper of the Scandes. In the low alpine belt of the Norwegian Scandes the species colonizes only the warmest microhabitats with maximum soil surface temperatures of 31℃. Vegetation of these habitats consists of shrub-rich heath dominated by Vaccinium myrtillus and Calluna vulgaris. Using continuously measured temperature data, the development times for four different seasons were modeled and related to field observations. The maximum delay of adult molt was estimated to amount to 3 weeks, the delay being determined by the variation in spring temperature conditions between different years. The possibilities of using M. frigidus as an indicator organism of climate change effects on alpine zoo-coenoses of the Scandes are discussed.

  3. Stress-induced enhancement of fear conditioning and sensitization facilitates extinction-resistant and habituation-resistant fear behaviors in a novel animal model of posttraumatic stress disorder. (United States)

    Corley, Michael J; Caruso, Michael J; Takahashi, Lorey K


    Posttraumatic stress disorder (PTSD) is characterized by stress-induced symptoms including exaggerated fear memories, hypervigilance and hyperarousal. However, we are unaware of an animal model that investigates these hallmarks of PTSD especially in relation to fear extinction and habituation. Therefore, to develop a valid animal model of PTSD, we exposed rats to different intensities of footshock stress to determine their effects on either auditory predator odor fear extinction or habituation of fear sensitization. In Experiment 1, rats were exposed to acute footshock stress (no shock control, 0.4 mA, or 0.8 mA) immediately prior to auditory fear conditioning training involving the pairing of auditory clicks with a cloth containing cat odor. When presented to the conditioned auditory clicks in the next 5 days of extinction testing conducted in a runway apparatus with a hide box, rats in the two shock groups engaged in higher levels of freezing and head out vigilance-like behavior from the hide box than the no shock control group. This increase in fear behavior during extinction testing was likely due to auditory activation of the conditioned fear state because Experiment 2 demonstrated that conditioned fear behavior was not broadly increased in the absence of the conditioned auditory stimulus. Experiment 3 was then conducted to determine whether acute exposure to stress induces a habituation resistant sensitized fear state. We found that rats exposed to 0.8 mA footshock stress and subsequently tested for 5 days in the runway hide box apparatus with presentations of nonassociative auditory clicks exhibited high initial levels of freezing, followed by head out behavior and culminating in the occurrence of locomotor hyperactivity. In addition, Experiment 4 indicated that without delivery of nonassociative auditory clicks, 0.8 mA footshock stressed rats did not exhibit robust increases in sensitized freezing and locomotor hyperactivity, albeit head out vigilance

  4. The sensitivity of random polymer brush-lamellar polystyrene-b-polymethylmethacrylate block copolymer systems to process conditions. (United States)

    Borah, Dipu; Rasappa, Sozaraj; Senthamaraikannan, Ramsankar; Shaw, Matthew T; Holmes, Justin D; Morris, Michael A


    The use of random copolymer brushes (polystyrene-r-polymethylmethacrylate--PS-r-PMMA) to 'neutralise' substrate surfaces and ordain perpendicular orientation of the microphase separated lamellae in symmetric polystyrene-b-polymethylmethacrylate (PS-b-PMMA) block copolymers (BCPs) is well known. However, less well known is how the brushes interact with both the substrate and the BCP, and how this might change during thermal processing. A detailed study of changes in these films for different brush and diblock PS-b-PMMA molecular weights is reported here. In general, self-assembly and pattern formation is altered little, and a range of brush molecular weights are seen to be effective. However, on extended anneal times, the microphase separated films can undergo dimension changes and loss of order. This process is not related to any complex microphase separation dynamics but rather a degradation of methacrylate components in the film. The data suggest that care must be taken in interpretation of structural changes in these systems as being due to BCP only effects.

  5. Identifying the key elements of an education package to up-skill multidisciplinary adult specialist palliative care teams caring for young adults with life-limiting conditions: an online Delphi study (United States)

    Sivell, Stephanie; Lidstone, Victoria; Taubert, Mark; Thompson, Catherine; Nelson, Annmarie


    Objectives To collect the views of experts to inform the development of an education package for multidisciplinary adult specialist palliative care (SPC) teams caring for young people with life-limiting conditions. Methods A modified online Delphi process collated expert opinion on format, delivery and content of an education package to up-skill adult SPC teams. Round 1 participants (n=44) answered free-text questions, generating items for Round 2. In Round 2, 68 participants rated the extent to which they agreed/disagreed with the items on 5-point Likert-type scales. Median and mean scores assessed the importance of each item. IQR scores assessed level of consensus for each item; items lacking consensus were rerated by 35 participants in Round 3. Results In the Delphi, consensus was reached on a range of suggested formats, on who should deliver the training, and on several clinical, psychosocial and practical topics. Conclusions Development of a continuous/rolling programme of education, tailored for content and mode of delivery and incorporated into working practice is recommended. As a direct outcome of the results of this study, a series of six linked study days has been established, focusing specifically on the issues around caring for young adults with life-limiting conditions and palliative care needs. PMID:24670554

  6. Impacts of biological parameterization, initial conditions, and environmental forcing on parameter sensitivity and uncertainty in a marine ecosystem model for the Bering Sea (United States)

    Gibson, G. A.; Spitz, Y. H.


    We use a series of Monte Carlo experiments to explore simultaneously the sensitivity of the BEST marine ecosystem model to environmental forcing, initial conditions, and biological parameterizations. Twenty model output variables were examined for sensitivity. The true sensitivity of biological and environmental parameters becomes apparent only when each parameter is allowed to vary within its realistic range. Many biological parameters were important only to their corresponding variable, but several biological parameters, e.g., microzooplankton grazing and small phytoplankton doubling rate, were consistently very important to several output variables. Assuming realistic biological and environmental variability, the standard deviation about simulated mean mesozooplankton biomass ranged from 1 to 14 mg C m - 3 during the year. Annual primary productivity was not strongly correlated with temperature but was positively correlated with initial nitrate and light. Secondary productivity was positively correlated with primary productivity and negatively correlated with spring bloom timing. Mesozooplankton productivity was not correlated with water temperature, but a shift towards a system in which smaller zooplankton undertake a greater proportion of the secondary production as the water temperature increases appears likely. This approach to incorporating environmental variability within a sensitivity analysis could be extended to any ecosystem model to gain confidence in climate-driven ecosystem predictions.

  7. High Sensitivity C-reactive Protein Levels in Acute Ischemic Stroke and Subtypes: A study from a Tertiary Care Center

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    Jaydip Ray Chaudhuri


    Full Text Available Background: Stroke is a heterogeneous disease with several risk factors. High sensitivity C-reactive protein (hsCRP is a marker for cardiovascular and cerebrovascular diseases. Recent studies have shown that high hsCRP level is a risk factor for ischemic stroke. The objective of our study was to investigate the association of high hsCRP(> 3 mg/L levels with ischemic stroke and its subtypes in Indian patients.Methods: We recruited 210 consecutive acute stroke patients and 150 age and sex matched controls. Stroke patients were admitted within 72 hours of onset, at Yashoda Hospital, Hyderabad, India. The study period was from January 2011 to December 2012. All patients underwent tests as per standard protocol for stroke workup. Serum hsCRP level was assessed in all stroke patients and controls on the day of admission.Results: The mean hsCRP was significantly higher in stroke patients (3.8 ± 2.5 than controls (1.8 ± 1.5 (P < 0.001. High hsCRP had higher frequency in stroke patients 130 (61.9% compared to controls 10 (6.6%, P < 0.001. High hsCRP level was more prevalent in the stroke subtypes of cardioembolic stroke (83.3% and large artery atherosclerosis (72%. High hsCRP level was significantly associated with hypercholesterolemia (P = 0.001, age(P = 0.01, and mortality (0.04. After adjustment of regression analysis it was observed that high level hsCRP is independently associated with acute ischemic stroke (Odds 4.5; 95% CI: 2.5-12.2; especially the stroke subtypes of cardioembolic stroke, (odds ratio 3.4, 95% CI: 1.9-10.5 and large artery atherosclerosis (odds ratio 2.1, 95% CI: 1.5-3.8.Conclusion: High hsCRP level is strongly associated with and an independent predictor of acute ischemic stroke. The association was found in all ischemic stroke subtypes.

  8. Sensitivity of ocean circulation and sea-ice conditions to loss of West Antarctic ice shelves and ice sheet (United States)

    Bougamont, Marion; Hunke, Elizabeth C.; Tulaczyk, Slawek

    We use a global coupled ocean-sea ice model to test the hypothesis that the disintegration of the West Antarctic ice sheet (WAIS), or just its ice shelves, may modify ocean circulation and sea-ice conditions in the Southern Ocean. We compare the results of three model runs: (1) a control run with a standard (modern) configuration of landmask in West Antarctica, (2) a no-shelves run with West Antarctic ice shelves removed and (3) a no-WAIS run. In the latter two runs, up to a few million square kilometres of new sea surface area opens to sea-ice formation, causing the volume and extent of Antarctic sea-ice cover to increase compared with the control run. In general, near-surface waters are cooler around Antarctica in the no-shelves and no-WAIS model runs than in the control run, while warm intermediate and deep waters penetrate further south, increasing poleward heat transport. Varying regional responses to the imposed changes in landmask configuration are determined by the fact that Antarctic polynyas and fast ice develop in different parts of the model domain in each run. Model results suggest that changes in the extent of WAIS may modify oceanographic conditions in the Southern Ocean.

  9. Development of a highly sensitive chemiluminescent assay for hydrogen peroxide under neutral conditions using acridinium ester and its application to an enzyme immunoassay. (United States)

    Arakawa, Hidetoshi; Tsuruoka, Keiko; Ohno, Ken-ichi; Tajima, Noriko; Nagano, Hiromi


    We developed a highly sensitive chemiluminescent (CL) assay for hydrogen peroxide using 10-methyl-9-(phenoxycarbonyl) acridinium fluorosulfonate (PMAC) that produced chemiluminescence under neutral conditions and applied it to an enzyme immunoassay (EIA). One picomole of hydrogen peroxide could be detected using the optimized PMAC-CL method and 6.2 × 10(-20) mol β-D-galactosidase (β-gal) could be detected by combining an indoxyl derivative substrate and the proposed PMAC-CL method. This highly sensitive CL β-gal assay was applied to an EIA for thyroid-stimulating hormone (TSH) using β-gal as a label enzyme; 0.02-100.0 μU/mL TSH in human serum could be assayed directly and with high reproducibility.

  10. Identifying patients with advanced chronic conditions for a progressive palliative care approach: a cross-sectional study of prognostic indicators related to end-of-life trajectories (United States)

    Amblàs-Novellas, J; Murray, S A; Espaulella, J; Martinez-Muñoz, M; Blay, C; Gómez-Batiste, X


    Objectives 2 innovative concepts have lately been developed to radically improve the care of patients with advanced chronic conditions (PACC): early identification of palliative care (PC) needs and the 3 end-of-life trajectories in chronic illnesses (acute, intermittent and gradual dwindling). It is not clear (1) what indicators work best for this early identification and (2) if specific clinical indicators exist for each of these trajectories. The objectives of this study are to explore these 2 issues. Setting 3 primary care services, an acute care hospital, an intermediate care centre and 4 nursing homes in a mixed urban–rural district in Barcelona, Spain. Participants 782 patients (61.5% women) with a positive NECPAL CCOMS-ICO test, indicating they might benefit from a PC approach. Outcome measures The characteristics and distribution of the indicators of the NECPAL CCOMS-ICO tool are analysed with respect to the 3 trajectories and have been arranged by domain (functional, nutritional and cognitive status, emotional problems, geriatric syndromes, social vulnerability and others) and according to their static (severity) and dynamic (progression) properties. Results The common indicators associated with early end-of-life identification are functional (44.3%) and nutritional (30.7%) progression, emotional distress (21.9%) and geriatric syndromes (15.7% delirium, 11.2% falls). The rest of the indicators showed differences in the associations per illness trajectories (ppalliative approach. PMID:27645556

  11. Final Rules for Grandfathered Plans, Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, Dependent Coverage, Appeals, and Patient Protections Under the Affordable Care Act. Final rules. (United States)


    This document contains final regulations regarding grandfathered health plans, preexisting condition exclusions, lifetime and annual dollar limits on benefits, rescissions, coverage of dependent children to age 26, internal claims and appeal and external review processes, and patient protections under the Affordable Care Act. It finalizes changes to the proposed and interim final rules based on comments and incorporates subregulatory guidance issued since publication of the proposed and interim final rules.

  12. Comparing the Workload Perceptions of Identifying Patient Condition and Priorities of Care Among Burn Providers in Three Burn ICUs. (United States)

    McInnis, Ian; Murray, Sarah J; Serio-Melvin, Maria; Aden, James K; Mann-Salinas, Elizabeth; Chung, Kevin K; Huzar, Todd; Wolf, Steven; Nemeth, Christopher; Pamplin, Jeremy C

    Multidisciplinary rounds (MDRs) in the burn intensive care unit serve as an efficient means for clinicians to assess patient status and establish patient care priorities. Both tasks require significant cognitive work, the magnitude of which is relevant because increased cognitive work of task completion has been associated with increased error rates. We sought to quantify this workload during MDR using the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Research staff at three academic regional referral burn centers administered the NASA-TLX to clinicians during MDR. Clinicians assessed their workload associated with 1) "Identify(ing) if the patient is better, same, or worse than yesterday" and 2) "Identify(ing) the most important objectives of care for the patient today." Data were collected on clinician type, years of experience, and hours of direct patient care. Surveys were administered to 116 total clinicians, 41 physicians, 25 nurses, 13 medical students, and 37 clinicians in other roles. Clinicians with less experience reported more cognitive work when completing both tasks (P Clinicians in the "others" group (respiratory therapists, dieticians, pharmacists, etc.) reported less cognitive work than all other groups for both tasks (P clinician type and experience level when completing two key tasks. Less experience was associated with increased perceived work, potentially increasing mental error rates, and increasing risk to patients. Creating tools or work processes to reduce cognitive work may improve clinician performance.

  13. Sensitivity to initial conditions of a d -dimensional long-range-interacting quartic Fermi-Pasta-Ulam model: Universal scaling (United States)

    Bagchi, Debarshee; Tsallis, Constantino


    We introduce a generalized d -dimensional Fermi-Pasta-Ulam model in the presence of long-range interactions, and perform a first-principle study of its chaos for d =1 ,2 ,3 through large-scale numerical simulations. The nonlinear interaction is assumed to decay algebraically as dij -α (α ≥0 ) , {di j} being the distances between N oscillator sites. Starting from random initial conditions we compute the maximal Lyapunov exponent λmax as a function of N . Our N ≫1 results strongly indicate that λmax remains constant and positive for α /d >1 (implying strong chaos, mixing, and ergodicity), and that it vanishes like N-κ for 0 ≤α /d 1 . The value α /d =1 can therefore be seen as a critical point separating the ergodic regime from the anomalous one, κ playing a role analogous to that of an order parameter. This scaling law is consistent with Boltzmann-Gibbs statistics for α /d >1 , and possibly with q statistics for 0 ≤α /d <1 .

  14. Improving the Sensitivity and Functionality of Mobile Webcam-Based Fluorescence Detectors for Point-of-Care Diagnostics in Global Health

    Directory of Open Access Journals (Sweden)

    Reuven Rasooly


    Full Text Available Resource-poor countries and regions require effective, low-cost diagnostic devices for accurate identification and diagnosis of health conditions. Optical detection technologies used for many types of biological and clinical analysis can play a significant role in addressing this need, but must be sufficiently affordable and portable for use in global health settings. Most current clinical optical imaging technologies are accurate and sensitive, but also expensive and difficult to adapt for use in these settings. These challenges can be mitigated by taking advantage of affordable consumer electronics mobile devices such as webcams, mobile phones, charge-coupled device (CCD cameras, lasers, and LEDs. Low-cost, portable multi-wavelength fluorescence plate readers have been developed for many applications including detection of microbial toxins such as C. Botulinum A neurotoxin, Shiga toxin, and S. aureus enterotoxin B (SEB, and flow cytometry has been used to detect very low cell concentrations. However, the relatively low sensitivities of these devices limit their clinical utility. We have developed several approaches to improve their sensitivity presented here for webcam based fluorescence detectors, including (1 image stacking to improve signal-to-noise ratios; (2 lasers to enable fluorescence excitation for flow cytometry; and (3 streak imaging to capture the trajectory of a single cell, enabling imaging sensors with high noise levels to detect rare cell events. These approaches can also help to overcome some of the limitations of other low-cost optical detection technologies such as CCD or phone-based detectors (like high noise levels or low sensitivities, and provide for their use in low-cost medical diagnostics in resource-poor settings.

  15. RNA profiles of porcine embryos during genome activation reveal complex metabolic switch sensitive to in vitro conditions.

    Directory of Open Access Journals (Sweden)

    Olga Østrup

    Full Text Available Fertilization is followed by complex changes in cytoplasmic composition and extensive chromatin reprogramming which results in the abundant activation of totipotent embryonic genome at embryonic genome activation (EGA. While chromatin reprogramming has been widely studied in several species, only a handful of reports characterize changing transcriptome profiles and resulting metabolic changes in cleavage stage embryos. The aims of the current study were to investigate RNA profiles of in vivo developed (ivv and in vitro produced (ivt porcine embryos before (2-cell stage and after (late 4-cell stage EGA and determine major metabolic changes that regulate totipotency. The period before EGA was dominated by transcripts responsible for cell cycle regulation, mitosis, RNA translation and processing (including ribosomal machinery, protein catabolism, and chromatin remodelling. Following EGA an increase in the abundance of transcripts involved in transcription, translation, DNA metabolism, histone and chromatin modification, as well as protein catabolism was detected. The further analysis of members of overlapping GO terms revealed that despite that comparable cellular processes are taking place before and after EGA (RNA splicing, protein catabolism, different metabolic pathways are involved. This strongly suggests that a complex metabolic switch accompanies EGA. In vitro conditions significantly altered RNA profiles before EGA, and the character of these changes indicates that they originate from oocyte and are imposed either before oocyte aspiration or during in vitro maturation. IVT embryos have altered content of apoptotic factors, cell cycle regulation factors and spindle components, and transcription factors, which all may contribute to reduced developmental competence of embryos produced in vitro. Overall, our data are in good accordance with previously published, genome-wide profiling data in other species. Moreover, comparison with mouse and

  16. Sensitivity testing of the model set-up used for calculation of photochemical ozone creation potentials (POCP) under European conditions

    Energy Technology Data Exchange (ETDEWEB)

    Altenstedt, J.; Pleijel, K.


    Photochemical Ozone Creation Potentials (POCP) is a method to rank VOC, relative to other VOC, according to their ability to produce ground level ozone. To obtain POCP values valid under European conditions, a critical analysis of the POCP concept has been performed using the IVL photochemical trajectory model. The critical analysis has concentrated on three VOC (ethene, n-butane and o-xylene) and has analysed the effect on their POCP values when different model parameters were varied. The three species were chosen because of their different degradation mechanisms in the atmosphere and thus their different abilities to produce ozone. The model parameters which have been tested include background emissions, initial concentrations, dry deposition velocities, the features of the added point source and meteorological parameters. The critical analysis shows that the background emissions of NO{sub x} and VOC have a critical impact on the POCP values. The hour of the day for the point source emission also shows a large influence on the POCP values. Other model parameters which have been studied have not shown such large influence on the POCP values. Based on the critical analysis a model set-up for calculation of POCP is defined. The variations in POCP values due to changes in the background emissions of NO{sub x} and VOC are so large that they can not be disregarded in the calculation of POCP. It is recommended to calculate POCP ranges based on the extremes in POCP values instead of calculating site specific POCP values. Four individual emission scenarios which produced the extremes in POCP values in the analysis have been selected for future calculation of POCP ranges. The scenarios are constructed based on the emissions in Europe and the resulting POCP ranges are thus intended to be applicable within Europe 67 refs, 61 figs, 16 tabs

  17. [Optimal conditions for the functioning of a urease-based biosensor and pH-sensitive field transistors. Determination of urea in solution]. (United States)

    Bubriak, O A; Soldatkin, A P; Starodub, N F; El'skaia, A V; Shul'ga, A A; Strikha, V I


    The article deals with the optimal conditions of urea determination in solution by the enzyme sensor based on pH-sensitive field effect transistor. The dependence of response level on temperature, pH, ionic strength, buffer capacity were investigated. 10 mM phosphate buffer, pH 7.4 containing 200 mM NaCl is optimal for possible measurements of urea in diluted blood. Temperature change in the measured samples from 15 degrees to 30 degrees C does not affect the sensor signal value. Stability of immobilized ureas was investigated at storage under different conditions. In the presence of 1 mM EDTA activity of immobilized enzyme does not change during one month storage at 4 degrees C.

  18. O6-Methylguanine-Methyltransferase (MGMT Promoter Methylation Status in Glioma Stem-Like Cells is Correlated to Temozolomide Sensitivity Under Differentiation-Promoting Conditions

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    Lucie Karayan-Tapon


    Full Text Available Glioblastoma (GBM is the most malignant type of primary brain tumor with a very poor prognosis. The actual standard protocol of treatment for GBM patients consists of radiotherapy and concomitant temozolomide (TMZ. However, the therapeutic efficacy of this treatment is limited due to tumor recurrence and TMZ resistance. Recently isolated, glioma stem-like cells (GSCs are thought to represent the population of tumorigenic cells responsible for GBM resistance and recurrence following surgery and chemotherapy. In addition, MGMT (O6-methylguanine-methyltransferase methylation is considered as one of the principal mechanisms contributing to TMZ sensitivity of GBM. In this study we have isolated GSCs from 10 adult GBM patients and investigated the relationship between MGMT methylation status and Temozolomide (TMZ sensitivity of these lines grown either in stem-like or differentiation promoting conditions. Sensitivity to TMZ was significantly associated with MGMT methylation status in cells committed to differentiation but not in stem-like cells. In addition, patients harboring highly methylated MGMT promoters had a longer overall survival. These results reveal the importance of the differentiation process when considering the predictive value of MGMT status in GSCs for clinical response to TMZ.

  19. Psychometric Properties of a Generic, Patient-Centred Palliative Care Outcome Measure of Symptom Burden for People with Progressive Long Term Neurological Conditions (United States)

    Gao, Wei; Crosby, Vincent; Wilcock, Andrew; Burman, Rachael; Silber, Eli; Hepgul, Nilay; Chaudhuri, K Ray; Higginson, Irene J.


    Background There is no standard palliative care outcome measure for people with progressive long term neurological conditions (LTNC). This study aims to determine the psychometric properties of a new 8-item palliative care outcome scale of symptom burden (IPOS Neuro-S8) in this population. Data and Methods Data were merged from a Phase II palliative care intervention study in multiple sclerosis (MS) and a longitudinal observational study in idiopathic Parkinson’s disease (IPD), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). The IPOS Neuro-S8 was assessed for its data quality, score distribution, ceiling and floor effects, reliability, factor structure, convergent and discriminant validity, concurrent validity with generic (Palliative care Outcome Scale) and condition specific measures (Multiple Sclerosis Impact Scale; Non-motor Symptoms Questionnaire; Parkinson’s Disease Questionnaire), responsiveness and minimally clinically important difference. Results Of the 134 participants, MS patients had a mean Extended Disability Status Scale score 7.8 (SD = 1.0), patients with an IPD, MSA or PSP were in Hoehn & Yahr stage 3–5. The IPOS Neuro-S8 had high data quality (2% missing), mean score 8 (SD = 5; range 0–32), no ceiling effects, borderline floor effects, good internal consistency (Cronbach’s α = 0.7) and moderate test-retest reliability (intraclass coefficient = 0.6). The results supported a moderately correlated two-factor structure (Pearson’s r = 0.5). It was moderately correlated with generic and condition specific measures (Pearson’s r: 0.5–0.6). There was some evidence for discriminant validity in IPD, MSA and PSP (p = 0.020), and for good responsiveness and longitudinal construct validity. Conclusions IPOS Neuro-S8 shows acceptable to promising psychometric properties in common forms of progressive LTNCs. Future work needs to confirm these findings with larger samples and its usefulness in wider disease groups. PMID

  20. The problems of the providing the regions with health care infrastructure in conditions of increase of migratory mobility

    Directory of Open Access Journals (Sweden)

    Yelena Borisovna Bedrina


    Full Text Available Subject matter of the article is a question of the providing the newcomers to regions of the Russian Federation with healthcare infrastructure facilities. The purpose of the research is an assessment of level of this providing. On the basis of calculation of the integrated indicators of the development of health care infrastructure and the providing the population with healthcare infrastructure facilities the grouping of regions is carried out. By means of the two-dimensional analysis, we made a comparison of regions on indicators of arrival of the population and the above-named settlement indicators. The analysis of dynamics of the number change of healthcare infrastructure facilities during its reforming from 2005 to 2011 is performed. As a result of the research, the following conclusion is drawn: the level of investment into the regions as well as in its health care infrastructure do influence on the intensity of migratory flows, however, distribution of investments into health care facilities in regions does not take in to account the directions of migratory flows and poorly considers the population size of territories. This article may be interesting to the experts dealing with issues of development of regions.

  1. Defense Health Care: Better Tracking and Oversight Needed of Servicemember Separations for Non-Disability Mental Conditions (United States)


    mixes non-disability mental conditions with non-disability physical conditions, such as obesity , making it difficult to distinguish one type of...servicemembers be physically and psychologically suitable for military service. DOD policy permits an enlisted servicemember to be involuntarily separated...broad separation code. 12Examples of non-disability physical conditions for which servicemembers can be administratively separated include obesity and

  2. Isothermal strand displacement amplification (iSDA): a rapid and sensitive method of nucleic acid amplification for point-of-care diagnosis. (United States)

    Toley, Bhushan J; Covelli, Isabela; Belousov, Yevgeniy; Ramachandran, Sujatha; Kline, Enos; Scarr, Noah; Vermeulen, Nic; Mahoney, Walt; Lutz, Barry R; Yager, Paul


    We present a method of rapid isothermal amplification of DNA without initial heat denaturation of the template, and methods and probes for (a) real-time fluorescence detection and (b) lateral flow detection of amplicons. Isothermal strand displacement amplification (iSDA) can achieve >10(9)-fold amplification of the target sequence in isothermal DNA amplification methods. iSDA initiates at sites where DNA base pairs spontaneously open or transiently convert into Hoogsteen pairs, i.e. "breathe", and proceeds to exponential amplification by repeated nicking, extension, and displacement of single strands. We demonstrate successful iSDA amplification and lateral flow detection of 10 copies of a Staphylococcus aureus gene, NO.-inducible l-lactate dehydrogenase (ldh1) (Richardson, Libby, and Fang, Science, 2008, 319, 1672-1676), in a clean sample and 50 copies in the presence of high concentrations of genomic DNA and mucins in isothermal amplification reactions. Finally, we demonstrate the multiplexing capability of iSDA by the simultaneous amplification of the target gene and an engineered internal control sequence. The speed, sensitivity, and specificity of iSDA make it a powerful method for point-of-care molecular diagnosis.

  3. Approaches to managing uncertainty in people with life-limiting conditions: role of communication and palliative care. (United States)

    Etkind, S N; Koffman, J


    Patients with any major illness can expect to experience uncertainty about the nature of their illness, its treatment and their prognosis. Prognostic uncertainty is a particular source of patient distress among those living with life-limiting disease. Uncertainty also affects professionals and it has been argued that the level of professional tolerance of uncertainty can affect levels of investigation as well as healthcare resource use. We know that the way in which uncertainty is recognised, managed and communicated can have important impacts on patients' treatment and quality of life. Current approaches to uncertainty in life-limiting illness include the use of care bundles and approaches that focus on communication and education. The experience in communicating in difficult situations that specialist palliative care professionals can provide may also be of benefit for patients with life-limiting illness in the context of uncertainty. While there are a number of promising approaches to uncertainty, as yet few interventions targeted at recognising and addressing uncertainty have been fully evaluated and further research is needed in this area.

  4. Comparison of Surfactant Distributions in Pressure-Sensitive Adhesive Films Dried from Dispersion under Lab-Scale and Industrial Drying Conditions. (United States)

    Baesch, S; Siebel, D; Schmidt-Hansberg, B; Eichholz, C; Gerst, M; Scharfer, P; Schabel, W


    Film-forming latex dispersions are an important class of material systems for a variety of applications, for example, pressure-sensitive adhesives, which are used for the manufacturing of adhesive tapes and labels. The mechanisms occurring during drying have been under intense investigations in a number of literature works. Of special interest is the distribution of surfactants during the film formation. However, most of the studies are performed at experimental conditions very different from those usually encountered in industrial processes. This leaves the impact of the drying conditions and the resulting influence on the film properties unclear. In this work, two different 2-ethylhexyl-acrylate (EHA)-based adhesives with varying characteristics regarding glass transition temperature, surfactants, and particle size distribution were investigated on two different substrates. The drying conditions, defined by film temperature and mass transfer in the gas phase, were varied to emulate typical conditions encountered in the laboratory and industrial processes. Extreme conditions equivalent to air temperatures up to 250 °C in a belt dryer and drying rates of 12 g/(m(2)·s) were realized. The surfactant distributions were measured by means of 3D confocal Raman spectroscopy in the dry film. The surfactant distributions were found to differ significantly with drying conditions at moderate film temperatures. At elevated film temperatures the surfactant distributions are independent of the investigated gas side transport coefficients: the heat and mass transfer coefficient. Coating on substrates with significantly different surface energies has a large impact on surfactant concentration gradients, as the equilibrium between surface and bulk concentration changes. Dispersions with higher colloidal stability showed more homogeneous lateral surfactant distributions. These results indicate that the choice of the drying conditions, colloidal stability, and substrates is crucial

  5. Radiation-Sensitive Severe Combined Immunodeficiency: The arguments for and against conditioning prior to hematopoietic cell transplantation – What to do? (United States)

    Cowan, MJ; Gennery, AR


    Defects in DCLRE1C, PRKDC, LIG4, NHEJ1, and NBS1, involving the non-homologous end joining (NHEJ) DNA repair pathway, result in radiation-sensitive severe combined immunodeficiency (RS-SCID). Results of hematopoietic cell transplantation for RS-SCID suggest that minimizing exposure to alkylating agents and ionizing radiation is important for optimizing survival and minimizing late effects. However, use of pre-conditioning with alkylating agents is associated with a greater likelihood of full T and B cell reconstitution compared to no conditioning or immunosuppression alone. A reduced intensity regimen using fludarabine and low dose cyclophosphamide may be effective for patients with LIG4, NHEJ1 and NBS1 defects although more data are needed to confirm these findings and characterize late effects. For patients with mutations in DCLRE1C (Artemis-deficient SCID), there is no optimal approach that uses standard dose alkylating agents without significant late effects. Until non-chemotherapy agents, e.g., anti-CD45 or anti-CD117 become available, options include minimizing exposure to alkylators, e.g., single agent low dose targeted Busulfan or achieving T cell reconstitution followed several years later with a conditioning regimen to restore B cell immunity. Gene therapy for these disorders will eventually remove the issues of rejection and GvHD. Prospective multi- center studies are needed to evaluate these approaches in this rare but highly vulnerable patient population. PMID:26055221

  6. Improving Care for Children With Complex Needs (United States)


    Medically Complex Children; Care Coordination; Case Manager; Care Manager; Collaborative Care; Disease Management; Patient Care Team or Organization; Managed Care; Children With Chronic Conditions; Children With Special Health Care Needs; Shared Care Plan; Patient Care Plan; Health Care and Resource Utilization; Adherence to Care; Functional Status and Productivity; Health Related Quality of Life; Satisfaction With Care; Care Coordinator; Family Experience of Care; Quality Health Care

  7. Optimization of Extraction Conditions and Development of a Sensitive HPTLC Method for Estimation of Wedelolactone in different extracts of Eclipta alba

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    Kulkarni Savita


    Full Text Available Eclipta alba has been used in Ayurvedic medicine for treatment of various ailments. An attempt has been made to optimize different extraction conditions for Eclipta alba. Further an accurate, precise, reproducible and sensitive accurate, precise and reproducible (HPTLC method has been developed for the estimation of Wedelolactone in Eclipta alba. An attempt has been made to quantify wedelolactone in various extracts by HPTLC method. Precoated aluminum silica gel F plates were used as stationary phase and toluene: ethyl acetate (9:1 was used as mobile phase. This system was found to give compact spots for wedelolactone (RF value of 0.30 ± 0. 3 with a linearity range of 1 to 80 µg per spot. The proposed method was applied to evaluate efficiency of different methods of extraction i.e. percolation, maceration, hot solvent extraction (Soxhlet apparatus, supercritical fluid extraction, microwave, orbital shaker bath and sonication method for extraction of wedelolactone from Eclipta alba.

  8. Effect of the Brazilian conditional cash transfer and primary health care programs on the new case detection rate of leprosy.

    Directory of Open Access Journals (Sweden)

    Joilda Silva Nery


    Full Text Available Social determinants can affect the transmission of leprosy and its progression to disease. Not much is known about the effectiveness of welfare and primary health care policies on the reduction of leprosy occurrence. The aim of this study is to evaluate the impact of the Brazilian cash transfer (Bolsa Família Program-BFP and primary health care (Family Health Program-FHP programs on new case detection rate of leprosy.We conducted the study with a mixed ecological design, a combination of an ecological multiple-group and time-trend design in the period 2004-2011 with the Brazilian municipalities as unit of analysis. The main independent variables were the BFP and FHP coverage at the municipal level and the outcome was new case detection rate of leprosy. Leprosy new cases, BFP and FHP coverage, population and other relevant socio-demographic covariates were obtained from national databases. We used fixed-effects negative binomial models for panel data adjusted for relevant socio-demographic covariates. A total of 1,358 municipalities were included in the analysis. In the studied period, while the municipal coverage of BFP and FHP increased, the new case detection rate of leprosy decreased. Leprosy new case detection rate was significantly reduced in municipalities with consolidated BFP coverage (Risk Ratio 0.79; 95% CI  =0.74-0.83 and significantly increased in municipalities with FHP coverage in the medium (72-95% (Risk Ratio 1.05; 95% CI  =1.02-1.09 and higher coverage tertiles (>95% (Risk Ratio 1.12; 95% CI  =1.08-1.17.At the same time the Family Health Program had been effective in increasing the new case detection rate of leprosy in Brazil, the Bolsa Família Program was associated with a reduction of the new case detection rate of leprosy that we propose reflects a reduction in leprosy incidence.

  9. Study of oral care on improving cough reflex sensitivity of recurrent pneumonia patients%口腔护理提高再发肺炎患者咳嗽反射敏感性的研究

    Institute of Scientific and Technical Information of China (English)

    韩则政; 刘慧; 方燕红; 程爱红; 赵欢欢; 余红梅; 吴长蓉


    Objective To explore the effects of oral care on improving cough reflex sensitivity and prolonging time span of recurrent pneumonia. Methods Oral care was conducted among 19 pateints with recurrent pneumonia. Using capsaicin-induced cough reflex method, cough reflex thresholds were measured in 19 patients with recurrent pneumonia before the study began, at the 20th day and the twelfth month after the study began. The recorrent time spans were recorded before and after the oral care at the same time. Results Cough reflex threshold was (1.54±0.06) mmol at the 20th day after the oral care began, which was significantly lower than (2.13±0.05) mmol before the the oral care began (P0.05). Pneumonia recurrent time span (210±54)days was significandy longer after performing the oral care than that (143±71)days of before performing the oral care (P0.05);口腔护理后肺炎再发间隔时间为(210±54)d,显著长于口腔护理前的(143±71)d(P<0.05).结论 口腔护理可以提高再发肺炎患者咳嗽反射的敏感性,延长肺炎再发的间隔时间.

  10. Dysarthria - care (United States)

    Speech and language disorder - dysarthria care; Slurred speech - dysarthria; Articulation disorder - dysarthria ... Dysarthria is a condition that occurs when there are problems with the muscles that help you talk. ...

  11. How Veterans With Post-Traumatic Stress Disorder and Comorbid Health Conditions Utilize eHealth to Manage Their Health Care Needs: A Mixed-Methods Analysis (United States)

    Jenchura, Emily C; Wong, Ava C; Zulman, Donna M


    Background Mental health conditions are prevalent among US veterans and pose a number of self-management and health care navigation challenges. Post-Traumatic Stress Disorder (PTSD) with comorbid chronic medical conditions (CMCs) is especially common, in both returning Iraq or Afghanistan and earlier war-era veterans. Patient-facing electronic health (eHealth) technology may offer innovative strategies to support these individuals’ needs. Objective This study was designed to identify the types of eHealth tools that veterans with PTSD and comorbid CMCs use, understand how they currently use eHealth technology to self-manage their unique health care needs, and identify new eHealth resources that veterans feel would empower them to better manage their health care. Methods A total of 119 veterans with PTSD and at least one CMC who have used the electronic personal health record system of the US Department of Veterans Affairs (VA) responded to a mailed survey about their chronic conditions and preferences related to the use of technology. After the survey, 2 focus groups, stratified by sex, were conducted with a subgroup of patients to explore how veterans with PTSD and comorbid CMCs use eHealth technology to support their complex health care needs. Focus groups were transcribed verbatim and analyzed using standard content analysis methods for coding textual data, guided by the “Fit between Individual, Task, and Technology” framework. Results Survey respondents had a mean age of 64.0 (SD 12.0) years, 85.1% (97/114) were male, 72.4% (84/116) were white, and 63.1% (70/111) had an annual household income of < US $50,000. Mean score on a measure of eHealth literacy was 27.7 (SD 9.8). Of the respondents, 44.6% (50/112) used health-related technology 1 to 3 times per month and 21.4% (24/112) used technology less than once per month. Veterans reported using technology most often to search for health information (78.9%, 90/114), communicate with providers (71.1%, 81

  12. The influence of short-term strength on the notch sensitivity and crack growth resistance of the metal of rotors under creep conditions (United States)

    Gladshtein, V. I.


    Comparative assessment of the effect the yield strength has on the characteristics of EI-415 steel under creep conditions is carried out based on the results from long-term (for more than 70000 h) tests of notched samples at an elevated temperature. The metal of three rotors (EI-415 steel) (one after it had been in operation for 137000 h and the other two in the delivery state with relatively increased and decreased levels of yield strength) was used as material under study. The notch sensitivity was evaluated from the ratio between the long-term strength of smooth samples and that of notched samples tested for long-term strength with recording the crack opening width. The resistances to crack incipience and to crack growth with a preset rate were determined from the lengths of cracks appeared at the end of two auxiliary notches of a smaller depth, and the creep fracture toughness was calculated from the break conditions. It is shown that the metal the properties of which are at the lower boundary of yield strength requirements is slightly more advantageous in the level of the above-mentioned characteristics.

  13. Improvement of the Laser-Induced Breakdown Spectroscopy method sensitivity by the usage of combination of Ag-nanoparticles and vacuum conditions (United States)

    Sládková, Lucia; Prochazka, David; Pořízka, Pavel; Škarková, Pavlína; Remešová, Michaela; Hrdlička, Aleš; Novotný, Karel; Čelko, Ladislav; Kaiser, Jozef


    In this work we studied the effect of vacuum (low pressure) conditions on the behavior of laser-induced plasma (LIP) created on a sample surface covered with silver nanoparticles (Ag-NPs), i.e. Nanoparticles-Enhanced Laser-Induced Breakdown Spectroscopy (NELIBS) experiment in a vacuum. The focus was put on the step by step optimization of the measurement parameters, such as energy of the laser pulse, temporally resolved detection, ambient pressure, and different content of Ag-NPs applied on the sample surface. The measurement parameters were optimized in order to achieve the greatest enhancement represented as the signal-to-noise ratio (SNR) of NELIBS signal to the SNR of LIBS signal. The presence of NPs involved in the ablation process enhances LIP intensity; hence the improvement in the analytical sensitivity was yielded. A leaded brass standard was analyzed with the emphasis on the signal enhancement of Pb traces. We gained enhancement by a factor of four. Although the low pressure had no significant influence on the LIP signal enhancement compared to that under ambient conditions, the SNR values were noticeably improved with the implementation of the NPs.

  14. Redox conditions in the atmosphere and shallow-marine environments during the first Huronian deglaciation: Insights from Os isotopes and redox-sensitive elements (United States)

    Goto, Kosuke T.; Sekine, Yasuhito; Suzuki, Katsuhiko; Tajika, Eiichi; Senda, Ryoko; Nozaki, Tatsuo; Tada, Ryuji; Goto, Kazuhisa; Yamamoto, Shinji; Maruoka, Teruyuki; Ohkouchi, Naohiko; Ogawa, Nanako O.


    The Paleoproterozoic (2.5-2.0 Ga) is one of the most important periods in Earth's history, and was characterized by a rise in atmospheric oxygen levels and repeated (at least three) severe glaciations (the Huronian glaciations). In this study, we investigate redox conditions in the atmosphere and in shallow-marine environments immediately after the first Huronian glaciation based on the isotopic composition of Os, and the abundance of redox-sensitive elements (Os, Re, and Mo) in sedimentary rocks from the Huronian Supergroup, Canada. We found no significant authigenic enrichment of Os in the sedimentary rocks deposited during the first Huronian deglaciation. The initial isotopic composition of Os in the sediments was close to that of chondrite at the time of deposition (Os187/188Os=∼0.11). These results suggest that atmospheric O2 levels were insufficient to mobilize radiogenic Os through continental weathering (pO210-8-10-5 PAL). Despite the Re enrichment, low abundances of Mo imply possible non-sulfidic conditions in shallow-marine environments at the time of deposition. Together with the results of organic carbon and sulfur analyses, we suggest that atmospheric O2 remained at relatively low levels of around 10-8-10-5 PAL after the first Huronian deglaciation, which contrasts with proposed dramatic increases in O2 after the second and third Huronian deglaciations. These results imply that the second and third Huronian glaciations may have been global events, associated with climatic jumps from severe glaciations to super-greenhouse conditions and the subsequent blooming of photosynthetic cyanobacteria in the glacial aftermath.

  15. Availability of N-Methyl-d-Aspartate Receptor Coagonists Affects Cocaine-Induced Conditioned Place Preference and Locomotor Sensitization: Implications for Comorbid Schizophrenia and Substance Abuse. (United States)

    Puhl, Matthew D; Berg, Alexandra R; Bechtholt, Anita J; Coyle, Joseph T


    Schizophrenia is associated with high prevalence of substance abuse. Recent research suggests that dysregulation of N-methyl-d-aspartate receptor (NMDAR) function may play a role in the pathophysiology of both schizophrenia and drug addiction, and thus, may account for this high comorbidity. Our laboratory has developed two transgenic mouse lines that exhibit contrasting NMDAR activity based on the availability of the glycine modulatory site (GMS) agonists d-serine and glycine. Glycine transporter 1 knockdowns (GlyT1(+/-)) exhibit NMDAR hyperfunction, whereas serine racemase knockouts (SR(-/-)) exhibit NMDAR hypofunction. We characterized the behavior of these lines in a cocaine-induced (20 mg/kg) conditioned place preference (CPP) and locomotor sensitization paradigm. Compared with wild-type mice, GlyT1(+/-) mice displayed hastened extinction of CPP and robust cocaine-induced reinstatement. SR(-/-) mice appeared to immediately "forget" the learned preference, because they did not exhibit cocaine-induced reinstatement and also displayed attenuated locomotor sensitization. Treatment of GlyT1(+/-) mice with gavestinel (10 mg/kg on day 1; 5 mg/kg on days 2-17), a GMS antagonist, attenuated cocaine-induced CPP and caused them to immediately "forget" the learned preference. Treatment of SR(-/-) mice with d-serine (300 mg/kg on day 1; 150 mg/kg on days 2-17) to normalize brain levels caused them to avoid the cocaine-paired side of the chamber during extinction. These results highlight NMDAR dysfunction as a possible neural mechanism underlying comorbid schizophrenia and substance abuse. Also, these findings suggest drugs that directly or indirectly activate the NMDAR GMS could be an effective treatment of cocaine abuse.

  16. Regional climate simulations over South America: sensitivity to model physics and to the treatment of lateral boundary conditions using the MM5 model

    Energy Technology Data Exchange (ETDEWEB)

    Solman, Silvina A. [CONICET-UBA, Centro de Investigaciones del Mar y la Atmosfera (CIMA), Buenos Aires (Argentina); Universidad de Buenos Aires, Departamento de Ciencias de la Atmosfera y los Oceanos. Facultad de Ciencias Exactas y Naturales, Buenos Aires (Argentina); Pessacg, Natalia L. [CONICET-UBA, Centro de Investigaciones del Mar y la Atmosfera (CIMA), Buenos Aires (Argentina)


    In this study the capability of the MM5 model in simulating the main mode of intraseasonal variability during the warm season over South America is evaluated through a series of sensitivity experiments. Several 3-month simulations nested into ERA40 reanalysis were carried out using different cumulus schemes and planetary boundary layer schemes in an attempt to define the optimal combination of physical parameterizations for simulating alternating wet and dry conditions over La Plata Basin (LPB) and the South Atlantic Convergence Zone regions, respectively. The results were compared with different observational datasets and model evaluation was performed taking into account the spatial distribution of monthly precipitation and daily statistics of precipitation over the target regions. Though every experiment was able to capture the contrasting behavior of the precipitation during the simulated period, precipitation was largely underestimated particularly over the LPB region, mainly due to a misrepresentation in the moisture flux convergence. Experiments using grid nudging of the winds above the planetary boundary layer showed a better performance compared with those in which no constrains were imposed to the regional circulation within the model domain. Overall, no single experiment was found to perform the best over the entire domain and during the two contrasting months. The experiment that outperforms depends on the area of interest, being the simulation using the Grell (Kain-Fritsch) cumulus scheme in combination with the MRF planetary boundary layer scheme more adequate for subtropical (tropical) latitudes. The ensemble of the sensitivity experiments showed a better performance compared with any individual experiment. (orig.)

  17. Use of dimedone-based chemical probes for sulfenic acid detection evaluation of conditions affecting probe incorporation into redox-sensitive proteins. (United States)

    Klomsiri, Chananat; Nelson, Kimberly J; Bechtold, Erika; Soito, Laura; Johnson, Lynnette C; Lowther, W Todd; Ryu, Seong-Eon; King, S Bruce; Furdui, Cristina M; Poole, Leslie B


    Sulfenic acids, formed as transient intermediates during the reaction of cysteine residues with peroxides, play significant roles in enzyme catalysis and regulation, and are also involved in the redox regulation of transcription factors and other signaling proteins. Therefore, interest in the identification of protein sulfenic acids has grown substantially in the past few years. Dimedone, which specifically traps sulfenic acids, has provided the basis for the synthesis of a novel group of compounds that derivatize 1,3-cyclohexadione, a dimedone analogue, with reporter tags such as biotin for affinity capture and fluorescent labels for visual detection. These reagents allow identification of the cysteine sites and proteins that are sensitive to oxidation and permit identification of the cellular conditions under which such oxidations occur. We have shown that these compounds are reactive and specific toward sulfenic acids and that the labeled proteins can be detected at high sensitivity using gel analysis or mass spectrometry. Here, we further characterize these reagents, showing that the DCP-Bio1 incorporation rates into three sulfenic acid containing proteins, papaya papain, Escherichia coli fRMsr, and the Salmonella typhimurium peroxiredoxin AhpC, are significantly different and, in the case of fRMsr, are unaffected by changes in buffer pH from 5.5 and 8.0. We also provide protocols to label protein sulfenic acids in cellular proteins, either by in situ labeling of intact cells or by labeling at the time of lysis. We show that the addition of alkylating reagents and catalase to the lysis buffer is critical in preventing the formation of sulfenic acid subsequent to cell lysis. Data presented herein also indicate that the need to standardize, as much as possible, the protein and reagent concentrations during labeling. Finally, we introduce several new test or control proteins that can be used to evaluate labeling procedures and efficiencies.

  18. Exocytosis sensitivity to growth hormone-releasing hormone in subsets of GH cells in rats under different corticosterone conditions. Ultrastructural study using microwave irradiation for fixation and immunocytochemistry. (United States)

    Ozawa, Hitoshi; Han, Fang; Kawata, Mitsuhiro


    Growth hormone (GH) cells in the rat anterior pituitary have been morphologically classified into three subtypes: type I (mature) containing large secretory granules about 350 nm in diameter, type II (intermediate) containing a mixture of large and small granules, and type III (immature) containing small granules about 150 nm in diameter. However, the functional implications of morphological heterogeneity, especially the different sensitivities to growth hormone-releasing hormone (GRH) under different corticosteroid conditions have not been elucidated to date. In the present study, by application of microwave irradiation (MWI) for fixation and immunocytochemistry, new findings of the exocytotic response have been revealed among the subsets of GH cells following adrenalectomy (ADX), corticosterone treatment and/or GRH treatment. The MWI gave effective results for fixation, especially for the permeability of the fixative, and showed good results for immunoelectron microscopy using the protein-A gold method. Moreover, the use of MWI greatly shortened the fixation, processing and immunolabeling times without compromising the quality of ultrastructural preservation and the specificity of labeling. The number of exocytotic figures was low in all subtypes of GH cells in the sham-operated control rats. GRH treatment induced a significant increase in exocytosis in each subtype of GH cells, particularly in type I (mature) and type II (intermediate) GH cells in the control rats. GRH injection to rats for 4 days after ADX also showed an increase in exocytosis, but the degree was significantly less in comparison with the GRH injection in the control group. Corticosterone replacement given to ADX rats induced a clear recovery of the exocytotic response to GRH to the control level. Serum GH content measured by radioimmunoassay correlated with these morphological results. These results suggest that the secretion of GH stimulated by GRH is closely related to corticosteroids, and

  19. Does a medical history of hypertension influence disclosing genetic testing results of the risk for salt-sensitive hypertension, in primary care?

    Directory of Open Access Journals (Sweden)

    Okayama M


    Full Text Available Masanobu Okayama,1,2 Taro Takeshima,2 Masanori Harada,3 Ryusuke Ae,4 Eiji Kajii2 1Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe, Hyogo, 2Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, 3Department of Support of Rural Medicine, Yamaguchi Grand Medical Center, Hofu, Yamaguchi, 4Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan Objective: Disclosing genetic testing results may contribute to the prevention and management of many common diseases. However, whether the presence of a disease influences these effects is unclear. This study aimed to clarify the difference in the effects of disclosing genetic testing results of the risk for developing salt-sensitive hypertension on the behavioral modifications with respect to salt intake in hypertensive and nonhypertensive patients.Methods: A cross-sectional study using a self-administered questionnaire was conducted for outpatients aged >20 years (N=2,237 at six primary care clinics and hospitals in Japan. The main factors assessed were medical histories of hypertension, salt preferences, reduced salt intakes, and behavior modifications for reducing salt intake. Behavioral modifications of participants were assessed using their behavior stages before and after disclosure of the hypothetical genetic testing results. Results: Of the 2,237 participants, 1,644 (73.5% responded to the survey. Of these respondents, 558 (33.9% patients were hypertensive and 1,086 (66.1% were nonhypertensive. After being notified of the result “If with genetic risk”, the nonhypertensive participants were more likely to make positive behavioral modifications compared to the hypertensive patients among all participants and in those aged <65 years (adjusted relative ratio [ad-RR], 1.76; 95% confidence interval, 1.12−2.76 and ad-RR, 1

  20. Dense water formation in the north-western Mediterranean area during HyMeX-SOP2 in 1/36° ocean simulations: Sensitivity to initial conditions (United States)

    Léger, Fabien; Lebeaupin Brossier, Cindy; Giordani, Hervé; Arsouze, Thomas; Beuvier, Jonathan; Bouin, Marie-Noëlle; Bresson, Émilie; Ducrocq, Véronique; Fourrié, Nadia; Nuret, Mathieu


    The north-western Mediterranean Sea is a key location where intense air-sea exchanges occur in autumn and winter. The succession of strong mistral and tramontane situations, leading to significant evaporation and ocean heat loss, is well known as the controlling factor in the dense water formation (DWF) with deep convection episodes. During HyMeX-SOP2 (1 February to 15 March 2013), several platforms sampled the area in order to document DWF and air-sea exchanges. This study investigates the ability of the NEMO-WMED36 ocean model (1/36°-resolution), driven in surface by the hourly air-sea fluxes from the AROME-WMED forecasts (2.5 km resolution), to represent DWF during HyMeX-SOP2 and focuses on the sensitivity to initial conditions. After a short evaluation of the atmospheric forcing, the high-resolution oceanic simulations using three different data sets as initial and boundary conditions are compared to observations collected during the field campaign. It evidences that using regional model outputs may lead to unrealistic thermohaline characteristics for the intermediate and deep waters, which degrade the simulated new dense water formed. Using ocean analyses built from observations, permits to obtain more realistic characteristics of the Western Mediterranean dense water. However, a low stratification favors an overestimation of the convective area and of the DWF rate. The DWF chronology is also impacted. Nevertheless, in every run, SOP2 is characterized by the production of water denser than 29.11 kg m-3 with a peak during the strong mistral event of 23-25 February followed by a period of restratification, before a last event of bottom convection on 13-15 March.

  1. A study on the bacteriological profile of urinary tract infection in adults and their antibiotic sensitivity pattern in a tertiary care hospital in central Kerala, India

    Directory of Open Access Journals (Sweden)

    Jubina Bency A. T.


    Conclusions: In this study, females were mostly affected and the most common organisms were E.Coli and Klebsiella. These organisms were most sensitive to Amikacin, Nitrofurantoin and resistant predominantly to Ampicillin. The sensitivity and resistance pattern of uropathogens to common antimicrobial agents must be taken into account when selecting treatment plans for UTI.

  2. Palliative care: a challenge for orthopaedic nursing care. (United States)

    Watters, Carol L; Harvey, Carol V; Meehan, Anita J; Schoenly, Lorry


    Patients who face chronic, incurable, or life-ending musculoskeletal conditions often receive inadequate care either due to a lack of caregiver awareness or inattention to maintaining the highest quality at the end of life. Palliative care focuses on the comprehensive physical, psychological, social, spiritual, and existential needs of patients with life-threatening or debilitating illness. Orthopaedic nurses and all nurses in general are challenged to incorporate palliative care principles into care planned with patients and families facing end-of-life issues. This article addresses the leadership role the National Association of Orthopaedic Nurses (NAON) has taken to develop a consensus document which endorses the Last Acts Precepts of Palliative Care and affirms the need for palliative care with patients who experience life-threatening illness. A case study is used to illustrate the opportunity a multidisciplinary team has to center care on the individual, while remaining sensitive to the holistic needs of the patient for self-determination at the end of life.

  3. A new coupled ice sheet/climate model: description and sensitivity to model physics under Eemian, Last Glacial Maximum, late Holocene and modern climate conditions

    Directory of Open Access Journals (Sweden)

    J. G. Fyke


    Full Text Available The need to better understand long-term climate/ice sheet feedback loops is motivating efforts to couple ice sheet models into Earth System models which are capable of long-timescale simulations. In this paper we describe a coupled model that consists of the University of Victoria Earth System Climate Model (UVic ESCM and the Pennsylvania State University Ice model (PSUI. The climate model generates a surface mass balance (SMB field via a sub-gridded surface energy/moisture balance model that resolves narrow ice sheet ablation zones. The ice model returns revised elevation, surface albedo and ice area fields, plus coastal fluxes of heat and moisture. An arbitrary number of ice sheets can be simulated, each on their own high-resolution grid and each capable of synchronous or asynchronous coupling with the overlying climate model. The model is designed to conserve global heat and moisture. In the process of improving model performance we developed a procedure to account for modelled surface air temperature (SAT biases within the energy/moisture balance surface model and improved the UVic ESCM snow surface scheme through addition of variable albedos and refreezing over the ice sheet.

    A number of simulations for late Holocene, Last Glacial Maximum (LGM, and Eemian climate boundary conditions were carried out to explore the sensitivity of the coupled model and identify model configurations that best represented these climate states. The modelled SAT bias was found to play a significant role in long-term ice sheet evolution, as was the effect of refreezing meltwater and surface albedo. The bias-corrected model was able to reasonably capture important aspects of the Antarctic and Greenland ice sheets, including modern SMB and ice distribution. The simulated northern Greenland ice sheet was found to be prone to ice margin retreat at radiative forcings corresponding closely to those of the Eemian or the present-day.

  4. An ensemble study of HyMeX IOP6 and IOP7a: sensitivity to physical and initial and boundary condition uncertainties

    Directory of Open Access Journals (Sweden)

    A. Hally


    Full Text Available The first Special Observation Period of the HyMeX campaign took place in the Mediterranean between September and November 2012 with the aim of better understanding the mechanisms which lead to heavy precipitation events (HPEs in the region during the autumn months. Two such events, referred to as Intensive Observation Period 6 (IOP6 and Intensive Observation Period 7a (IOP7a, occurred respectively on 24 and 26 September over south-eastern France. IOP6 was characterised by moderate to weak low-level flow which led to heavy and concentrated convective rainfall over the plains near the coast, while IOP7a had strong low-level flow and consisted of a convective line over the mountainous regions further north and a band of stratiform rainfall further east. Firstly, an ensemble was constructed for each IOP using analyses from the AROME, AROME-WMED, ARPEGE and ECMWF operational models as initial (IC and boundary (BC conditions for the research model Meso-NH at a resolution of 2.5 km. A high level of model skill was seen for IOP7a, with a lower level of agreement with the observations for IOP6. Using the most accurate member of this ensemble as a CTRL simulation, three further ensembles were constructed in order to study uncertainties related to cloud physic and surface turbulence parameterisations. Perturbations were introduced by perturbing the time tendencies of the warm and cold microphysical and turbulence processes. An ensemble where all three sources of uncertainty were perturbed gave the greatest degree of dispersion in the surface rainfall for both IOPs. Comparing the level of dispersion to that of the ICBC ensemble demonstrated that when model skill is low (high and low-level flow is weak to moderate (strong, the level of dispersion of the ICBC and physical perturbation ensembles is (is not comparable. The level of sensitivity to these perturbations is thus concluded to be case dependent.

  5. An ensemble study of HyMeX IOP6 and IOP7a: sensitivity to physical and initial and boundary condition uncertainties (United States)

    Hally, A.; Richard, E.; Ducrocq, V.


    The first Special Observation Period of the HyMeX campaign took place in the Mediterranean between September and November 2012 with the aim of better understanding the mechanisms which lead to heavy precipitation events (HPEs) in the region during the autumn months. Two such events, referred to as Intensive Observation Period 6 (IOP6) and Intensive Observation Period 7a (IOP7a), occurred respectively on 24 and 26 September over south-eastern France. IOP6 was characterised by moderate to weak low-level flow which led to heavy and concentrated convective rainfall over the plains near the coast, while IOP7a had strong low-level flow and consisted of a convective line over the mountainous regions further north and a band of stratiform rainfall further east. Firstly, an ensemble was constructed for each IOP using analyses from the AROME, AROME-WMED, ARPEGE and ECMWF operational models as initial (IC) and boundary (BC) conditions for the research model Meso-NH at a resolution of 2.5 km. A high level of model skill was seen for IOP7a, with a lower level of agreement with the observations for IOP6. Using the most accurate member of this ensemble as a CTRL simulation, three further ensembles were constructed in order to study uncertainties related to cloud physics and surface turbulence parameterisations. Perturbations were introduced by perturbing the time tendencies of the warm and cold microphysical and turbulence processes. An ensemble where all three sources of uncertainty were perturbed gave the greatest degree of dispersion in the surface rainfall for both IOPs. Comparing the level of dispersion to that of the ICBC ensemble demonstrated that when model skill is low (high) and low-level flow is weak to moderate (strong), the level of dispersion of the ICBC and physical perturbation ensembles is (is not) comparable. The level of sensitivity to these perturbations is thus concluded to be case dependent.

  6. An ensemble study of HyMeX IOP6 and IOP7a: sensitivity to physical and initial and boundary condition uncertainties

    Directory of Open Access Journals (Sweden)

    A. Hally


    Full Text Available The first Special Observation Period of the HyMeX campaign took place in the Mediterranean between September and November 2012 with the aim of better understanding the mechanisms which lead to heavy precipitation events (HPEs in the region during the autumn months. Two such events, referred to as Intensive Observation Period 6 (IOP6 and Intensive Observation Period 7a (IOP7a, occurred respectively on 24 and 26 September over south-eastern France. IOP6 was characterised by moderate to weak low-level flow which led to heavy and concentrated convective rainfall over the plains near the coast, while IOP7a had strong low-level flow and consisted of a convective line over the mountainous regions further north and a band of stratiform rainfall further east. Firstly, an ensemble was constructed for each IOP using analyses from the AROME, AROME-WMED, ARPEGE and ECMWF operational models as initial (IC and boundary (BC conditions for the research model Meso-NH at a resolution of 2.5 km. A high level of model skill was seen for IOP7a, with a lower level of agreement with the observations for IOP6. Using the most accurate member of this ensemble as a CTRL simulation, three further ensembles were constructed in order to study uncertainties related to cloud physics and surface turbulence parameterisations. Perturbations were introduced by perturbing the time tendencies of the warm and cold microphysical and turbulence processes. An ensemble where all three sources of uncertainty were perturbed gave the greatest degree of dispersion in the surface rainfall for both IOPs. Comparing the level of dispersion to that of the ICBC ensemble demonstrated that when model skill is low (high and low-level flow is weak to moderate (strong, the level of dispersion of the ICBC and physical perturbation ensembles is (is not comparable. The level of sensitivity to these perturbations is thus concluded to be case dependent.

  7. A new coupled ice sheet-climate model: description and sensitivity to model physics under Eemian, Last Glacial Maximum, late Holocene and modern climate conditions

    Directory of Open Access Journals (Sweden)

    J. G. Fyke


    Full Text Available The need to better understand long-term climate/ice sheet feedback loops is motivating efforts to couple ice sheet models into Earth System models which are capable of long-timescale simulations. In this paper we describe a coupled model, that consists of the University of Victoria Earth System Climate Model (UVic ESCM and the Pennsylvania State University Ice model (PSUI. The climate model generates a surface mass balance (SMB field via a sub-gridded surface energy/moisture balance model that resolves narrow ice sheet ablation zones. The ice model returns revised elevation, surface albedo and ice area fields, plus coastal fluxes of heat and moisture. An arbitrary number of ice sheets can be simulated, each on their own high-resolution grid and each capable of synchronous or asynchronous coupling with the overlying climate model. The model is designed to conserve global heat and moisture. In the process of improving model performance we developed a procedure to account for modelled surface air temperature (SAT biases within the energy/moisture balance surface model and improved the UVic ESCM snow surface scheme through addition of variable albedos and refreezing over the ice sheet.

    A number of simulations for late Holocene, Last Glacial Maximum (LGM, and Eemian climate boundary conditions were carried out to explore the sensitivity of the coupled model and identify model configurations that best represented these climate states. The modelled SAT bias was found to play a significant role in long-term ice sheet evolution, as was the effect of refreezing meltwater and surface albedo. The bias-corrected model was able to reasonably capture important aspects of the Antarctic and Greenland ice sheets, including modern SMB and ice distribution. The simulated northern Greenland ice sheet was found to be prone to ice margin retreat at radiative forcings corresponding closely to those of the Eemian or the present-day.

  8. Something is amiss in Denmark: A comparison of preventable hospitalisations and readmissions for chronic medical conditions in the Danish Healthcare system and Kaiser Permanente

    DEFF Research Database (Denmark)

    Schiøtz, Michaela Louise; Price, Mary; Frølich, Anne;


    As many other European healthcare systems the Danish healthcare system (DHS) has targeted chronic condition care in its reform efforts. Benchmarking is a valuable tool to identify areas for improvement. Prior work indicates that chronic care coordination is poor in the DHS, especially in comparison...... with care in Kaiser Permanente (KP), an integrated delivery system based in the United States. We investigated population rates of hospitalisation and readmission rates for ambulatory care sensitive, chronic medical conditions in the two systems....

  9. Synergistic effects of pain intensity and anxiety sensitivity in relation to anxiety and depressive symptoms and disorders among economically disadvantaged latinos in a community-based primary care setting. (United States)

    Velasco, Ricardo Valdés; Bakhshaie, Jafar; Walker, Rheeda L; Viana, Andres G; Garza, Monica; Ochoa-Perez, Melissa; Paulus, Daniel J; Robles, Zuzuky; Valdivieso, Jeanette; Zvolensky, Michael J


    The present investigation examined the interactive effects of anxiety sensitivity and pain intensity in relation to anxious arousal, social anxiety, and depressive symptoms and disorders among 203 Latino adults with an annual income of less than $30,000 (84.4% female; Mage=38.9, SD=11.3 and 98.6% used Spanish as their first language) who attended a community-based primary healthcare clinic. As expected, the interaction between anxiety sensitivity and pain intensity was significantly related to increased anxious arousal, social anxiety, and depressive symptoms as well as number of depressive/anxiety disorder diagnoses. The form of the significant interactions indicated that participants reporting co-occurring higher levels of anxiety sensitivity and pain intensity evinced the greatest levels of anxious arousal, social anxiety, and depressive symptoms as well as higher levels of depressive and anxiety disorders. These data provide novel empirical evidence suggesting that there is clinically-relevant interplay between anxiety sensitivity and pain intensity in regard to a relatively wide array of anxiety and depressive variables among Latinos in a primary care medical setting.

  10. Diagnostic and prognostic value of a careful symptom evaluation and high sensitive troponin in patients with suspected stable angina pectoris without prior cardiovascular disease

    DEFF Research Database (Denmark)

    Madsen, Debbie M; Diederichsen, Axel C P; Hosbond, Susanne E


    BACKGROUND AND AIMS: Typical angina pectoris (AP) and high-sensitive troponin I (hs-TnI) are independently associated with coronary artery disease (CAD) and future cardiovascular events (CVE). This study aimed to assess the individual and combined diagnostic and prognostic impact of symptoms and hs...

  11. Can a Healthcare "Lean Sweep" Deliver on What Matters to Patients? Comment on "Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping". (United States)

    Verma, Jennifer Y; Amar, Claudia


    Disconnects and defects in care - such as duplication, poor integration between services or avoidable adverse events - are costly to the health system and potentially harmful to patients and families. For patients living with multiple chronic conditions, such disconnects can be particularly detrimental. Lean is an approach to optimizing value by reducing waste (eg, duplication and defects) and containing costs (eg, improving integration of services) as well as focusing on what matters to patients. Lean works particularly well to optimize existing processes and services. However, as the burden of chronic illness and frailty overtake episodic care needs, health systems require far greater complex, adaptive change. Such change ought to take into account outcomes in population health in addition to care experiences and costs (together, comprising the Triple Aim); and involve patients and families in co-designing new models of care that better address complex, longer-term health needs.

  12. Can a Healthcare “Lean Sweep” Deliver on What Matters to Patients?; Comment on “Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping”

    Directory of Open Access Journals (Sweden)

    Jennifer Y. Verma


    Full Text Available Disconnects and defects in care – such as duplication, poor integration between services or avoidable adverse events – are costly to the health system and potentially harmful to patients and families. For patients living with multiple chronic conditions, such disconnects can be particularly detrimental. Lean is an approach to optimizing value by reducing waste (eg, duplication and defects and containing costs (eg, improving integration of services as well as focusing on what matters to patients. Lean works particularly well to optimize existing processes and services. However, as the burden of chronic illness and frailty overtake episodic care needs, health systems require far greater complex, adaptive change. Such change ought to take into account outcomes in population health in addition to care experiences and costs (together, comprising the Triple Aim; and involve patients and families in co-designing new models of care that better address complex, longer-term health needs.

  13. Sensitivity Characteristic Analysis of Adsorbent-Mixed Carbon Nanotube Sensors for the Detection of SF6 Decomposition Products under PD Conditions

    Directory of Open Access Journals (Sweden)

    Ju Tang


    Full Text Available Sulfur hexafluoride (SF6 gas decomposition results from the energy produced by partial discharge (PD. The detection of SO2 and H2S content, as important characteristic components of the decomposition products, is significant in the determination of the insulation level of SF6 gas and the inside insulation faults of gas-insulated equipment. A number of gas sensors use carbon nanotubes (CNTs. However, the applications of these sensors are limited by their low intrinsic sensitivity. In this paper, an adsorbent-mixed carbon nanotube gas sensor is proposed to improve the detection of SO2 and H2S concentrations. The sensitivity of adsorbent-mixed carbon nanotube gas sensors to SO2 and H2S at 100 ppm was investigated experimentally. The effect of the mixing ratio on the gas sensitivity characteristic and mechanism of response was also studied. The results show that compared with intrinsic CNTs gas sensors, the gas sensor featuring adsorbent-mixed CNTs has significantly higher sensitivity and responsiveness to SO2 and H2S. The resistance-change rate of SO2 and H2S increased to 33.7% and 50.9% from 0.96% and 12.9%, respectively. Moreover, the resistance-change rate and gas concentration satisfy a linear relationship. The sensor has good repeatability and stability.

  14. [Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units]. (United States)

    Bambi, Stefano; Lucchini, Alberto; Solaro, Massimo; Lumini, Enrico; Rasero, Laura


    Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units. Over the past 15 years, the model of medical and nursing care changed from being exclusively oriented to the diagnosis and treatment of acute illness, to the achievement of outcomes by preventing iatrogenic complications (Hospital Acquired Conditions). Nursing Sensitive Outcomes show as nursing is directly involved in the development and prevention of these complications. Many of these complications, including falls from the bed, use of restraints, urinary catheter associated urinary infections and intravascular catheter related sepsis, are related to basic nursing care. Ten years ago in critical care, a school of thought called get back to the basics, was started for the prevention of errors and risks associated with nursing. Most of these nursing practices involve hygiene and mobilization. On the basis of these reflections, Kathleen Vollman developed a model of nursing care in critical care area, defined Interventional Patient Hygiene (IPH). The IPH model provides a proactive plan of nursing interventions to strengthen the patients' through the Evidence-Based Nursing Care. The components of the model include interventions of oral hygiene, mobilization, dressing changes, urinary catheter care, management of incontinence and bed bath, hand hygiene and skin antisepsis. The implementation of IPH model follows the steps of Deming cycle, and requires a deep reflection on the priorities of nursing care in ICU, as well as the effective teaching of the importance of the basic nursing to new generations of nurses.

  15. Medication as Infrastructure: Decentring Self-care

    Directory of Open Access Journals (Sweden)

    Peter Danholt


    Full Text Available Drawing on science and technology studies (STS, and specifically the concept of infrastructure as conceptualised by Bowker and Star (2000; Star 1999, this paper argues and empirically demonstrates that self-care may be considered a practice that is thoroughly sociotechnical, material, distributed and de-centred. Comparing the practices related to medication in the treatment of asthma, type 2 diabetes and haemophilia, we show that in practice there is no ‘self’ in self-care. More specifically, the ‘self’ in self-care is an actor who is highly dependent on, and intertwined with infrastructures of care, in order to be self-caring. Infrastructures of care are the more or less embedded ‘tracks’ along which care may ‘run’, shaping and being shaped by actors and settings along the way. Obtaining prescriptions, going to the pharmacy, bringing medication home and administering it as parts of daily life are commonplace activities embedded in the fabric of life, especially for those living with a chronic condition. However, this procurement and emplacement of medication involves the establishment and ongoing enactment of infrastructures of care, that is, the connections between various actors and locations that establish caring spaces and caring selves. Locations and actors are included as allies in treating chronic conditions outside the clinical setting, but these infrastructures may also be ambiguous, with respect to their effects; they may simultaneously contribute to the condition’s management and neglect. Particularly precarious is management at the fringes of healthcare infrastructure, where allies, routines and general predictability are scarce. We conclude by arguing that these insights may induce a greater sensitivity to existing infrastructures and practices, when seeking to introduce new infrastructures of care, such as those promoted under the headings of ‘telemedicine’ and ‘healthcare IT’.

  16. Improving regional variation using quality of care measures

    Directory of Open Access Journals (Sweden)

    Scott A Berkowitz


    Full Text Available Scott A Berkowitz1, Gary Gerstenblith1, Robert Herbert2, Gerard Anderson1,21Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Center for Hospital Finance and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USAAbstract: There is significant regional variability in the quality of care provided in the United States. This article compares regional performance for three measures that focus on transitions in care, and the care of patients with multiple conditions. Admissions for people with ambulatory care-sensitive conditions, hospital readmissions within 30 days of discharge, and compliance with practice guidelines for people with three chronic conditions (congestive heart failure, chronic obstructive pulmonary disease, and diabetes were analyzed using data drawn from the Centers for Medicare & Medicaid Services’ Standard Analytic Files for 5% of a 2004 national sample of Medicare beneficiaries which was divided by hospital referral regions and regional performance. There were significant regional differences in performance which we hypothesize could be improved through better care coordination and system management.Keywords: performance, quality, chronic condition, ambulatory care, sensitive conditions, readmissions

  17. Medicare Program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system changes and FY2011 rates; provider agreements and supplier approvals; and hospital conditions of participation for rehabilitation and respiratory care services; Medicaid program: accreditation for providers of inpatient psychiatric services. Final rules and interim final rule with comment period. (United States)


    : We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems and to implement certain provisions of the Affordable Care Act and other legislation. In addition, we describe the changes to the amounts and factors used to determine the rates for Medicare acute care hospital inpatient services for operating costs and capital-related costs. We also are setting forth the update to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. We are updating the payment policy and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and setting forth the changes to the payment rates, factors, and other payment rate policies under the LTCH PPS. In addition, we are finalizing the provisions of the August 27, 2009 interim final rule that implemented statutory provisions relating to payments to LTCHs and LTCH satellite facilities and increases in beds in existing LTCHs and LTCH satellite facilities under the LTCH PPS. We are making changes affecting the: Medicare conditions of participation for hospitals relating to the types of practitioners who may provide rehabilitation services and respiratory care services; and determination of the effective date of provider agreements and supplier approvals under Medicare. We are also setting forth provisions that offer psychiatric hospitals and hospitals with inpatient psychiatric programs increased flexibility in obtaining accreditation to participate in the Medicaid program. Psychiatric hospitals and hospitals with inpatient psychiatric programs will have the choice of undergoing a State survey or of obtaining accreditation from a national accrediting organization whose hospital accreditation

  18. Nitrogen-detected TROSY yields comparable sensitivity to proton-detected TROSY for non-deuterated, large proteins under physiological salt conditions

    Energy Technology Data Exchange (ETDEWEB)

    Takeuchi, Koh [National Institute for Advanced Industrial Science and Technology, Molecular Profiling Research Center for Drug Discovery (Japan); Arthanari, Haribabu [Harvard Medical School, Department of Biochemistry and Molecular Pharmacology (United States); Imai, Misaki [Japan Biological Informatics Consortium, Research and Development Department (Japan); Wagner, Gerhard, E-mail: [Harvard Medical School, Department of Biochemistry and Molecular Pharmacology (United States); Shimada, Ichio, E-mail: [National Institute for Advanced Industrial Science and Technology, Molecular Profiling Research Center for Drug Discovery (Japan)


    Direct detection of the TROSY component of proton-attached {sup 15}N nuclei ({sup 15}N-detected TROSY) yields high quality spectra with high field magnets, by taking advantage of the slow {sup 15}N transverse relaxation. The slow transverse relaxation and narrow line width of the {sup 15}N-detected TROSY resonances are expected to compensate for the inherently low {sup 15}N sensitivity. However, the sensitivity of {sup 15}N-detected TROSY in a previous report was one-order of magnitude lower than in the conventional {sup 1}H-detected version. This could be due to the fact that the previous experiments were performed at low salt (0–50 mM), which is advantageous for {sup 1}H-detected experiments. Here, we show that the sensitivity gap between {sup 15}N and {sup 1}H becomes marginal for a non-deuterated, large protein (τ{sub c} = 35 ns) at a physiological salt concentration (200 mM). This effect is due to the high salt tolerance of the {sup 15}N-detected TROSY. Together with the previously reported benefits of the {sup 15}N-detected TROSY, our results provide further support for the significance of this experiment for structural studies of macromolecules when using high field magnets near and above 1 GHz.

  19. Urinary infection in patients of public health care of Campo Mourão-PR, Brazil: bacterial prevalence and sensitivity profile

    Directory of Open Access Journals (Sweden)

    Josiane dos Santos Bitencourt


    Full Text Available Introduction: Cases of bacterial resistance in urinary tract infections (UTIs have increased significantly, mainly due to indiscriminate use of antimicrobials. Objective: Objective: To evaluate the prevalence and antimicrobial susceptibility of microorganisms isolated in urine cultures of patients of Consórcio Intermunicipal de Saúde da Comunidade dos Municípios da Região de Campo Mourão (CISCOMCAM clinical laboratory. Method: We performed a retrospective study of data from urine culture and sensitivity done between January 2012 and December 2013. Results: The most prevalent bacteria were Escherichia coli; women were the most affected gender and people 16-45 years, the most affected age group. The sensitivity profile showed that the antimicrobial combination trimethoprim/ sulfamethoxazole was not associated with the highest rate of bacterial resistance (59.7% and the combination of amoxicillin/clavulanic acid showed the lowest resistance rate (15.3%. For most antimicrobials, including ciprofloxacin and norfloxacin, the rates of bacterial resistance have increased from 2012 to 2013 with statistical significance (p < 0.05 in some cases. Discussion: The prevalence of Gram-negative bacilli in urinary infections is due to the fact that intestinal flora is rich in enterobacteria, and women are most affected by anatomical factors. The development of bacterial resistance to antimicrobials probably arises from their indiscriminate use. Conclusion: The rate of microbial resistance has risen, showing the need for a more effective control of antimicrobial use.

  20. Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings – Guideline of the German Society for Hospital Hygiene (DGKH

    Directory of Open Access Journals (Sweden)

    Külpmann, Rüdiger


    Full Text Available Since the publication of the first “Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems in hospitals” ( in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section “Ventilation and air conditioning technology” attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care.

  1. Influence of TiCl4 post-treatment condition on TiO2 electrode for enhancement photovoltaic efficiency of dye-sensitized solar cells. (United States)

    Eom, Tae Sung; Kim, Kyung Hwan; Bark, Chung Wung; Choi, Hyung Wook


    Titanium tetrachloride (TiCl4) treatment processed by chemical bath deposition is usually adopted as pre- and post-treatment for nanocrystalline titanium dioxide (TiO2) film deposition in the dye-sensitized solar cells (DSSCs) technology. TiCl4 post-treatment is a widely known method capable of improving the performance of dye-sensitized solar cells. In this work, the effect of TiCl4 post-treatment on the TiO2 electrode is proposed and compared to the untreated film. A TiO2 passivating layer was deposited on FTO glass by RF magnetron sputtering. The TiO2 sol prepared sol-gel method, nanoporous TiO2 upper layer was deposited by screen printing method on the passivating layer. TiCl4 post-treatment was deposited on the substrate by hydrolysis of TiCl4 aqueous solution. Crystalline structure was adjusted by various TiCl4 concentration and dipping time: 20 mM-150 mM and 30 min-120 min. The conversion efficiency was measured by solar simulator (100 mW/cm2). The dye-sensitized solar cell using TiCl4 post-treatment was measured the maximum conversion efficiency of 5.04% due to electron transport effectively. As a result, the DSSCs based on TiCl4 post-treatment showed better photovoltaic performance than cells made purely of TiO2 nanoparticles. The relative DSSCs devices are characterized in terms of short circuit current density, open circuit voltage, fill factor, conversion efficiency.

  2. Cobalt sensitization and dermatitis

    DEFF Research Database (Denmark)

    Thyssen, Jacob P


    : This clinical review article presents clinical and scientific data on cobalt sensitization and dermatitis. It is concluded that cobalt despite being a strong sensitizer and a prevalent contact allergen to come up on patch testing should be regarded as a very complex metal to test with. Exposure...... data together with clinical data from metal workers heavily exposed to cobalt suggest that patch-test reactions are sometimes false positive and that patch testers should carefully evaluate their clinical relevance....

  3. Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians

    Directory of Open Access Journals (Sweden)

    Skedros John G


    Full Text Available Abstract Background Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs and physical medicine and rehabilitation (PMRs physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines. Methods 264 surveys, sent to these physicians in our tri-state area of the western United States, addressed corticosteroid/anesthetic doses and types used for subacromial impingement, degenerative glenohumeral and acromioclavicular arthritis, biceps tendinitis, and peri-scapular trigger points. They were asked about preferences regarding: 1 fluorinated vs. non-fluorinated corticosteroids, 2 acetate vs. phosphate types, 3 patient age, and 4 adjustments for special considerations including young athletes and diabetics. Results 169 (64% response rate, RR surveys were returned: 105/163 orthopaedic surgeons (64%RR, 44/77 PCSMs/PMRs (57%RR, 20/24 rheumatologists (83%RR. Although corticosteroid doses do not differ significantly between specialties (p > 0.3, anesthetic volumes show broad variations, with surgeons using larger volumes. Although 29% of PCSMs/PMRs, 44% rheumatologists, and 41% surgeons exceed "recommended" doses for the acromioclavicular joint, >98% were within recommendations for the subacromial bursa and glenohumeral joint. Depo-Medrol® (methylprednisolone acetate and Kenalog® (triamcinolone acetonide are most commonly used. More rheumatologists (80% were aware that there are acetate and phosphate types of corticosteroids as compared to PCSMs/PMRs (76% and orthopaedists (60%. However, relatively fewer rheumatologists (25% than PCSMs/PMRs (32% or orthopaedists (32% knew that phosphate types are more soluble. Fluorinated corticosteroids, which can be deleterious to soft tissues, were used with these frequencies for the biceps sheath: 17% rheumatologists, 8% PCSMs/PMRs, 37

  4. Molecular typing of toxic shock syndrome toxin-1- and Enterotoxin A-producing methicillin-sensitive Staphylococcus aureus isolates from an outbreak in a neonatal intensive care unit. (United States)

    Layer, Franziska; Sanchini, Andrea; Strommenger, Birgit; Cuny, Christiane; Breier, Ann-Christin; Proquitté, Hans; Bührer, Christoph; Schenkel, Karl; Bätzing-Feigenbaum, Jörg; Greutelaers, Benedikt; Nübel, Ulrich; Gastmeier, Petra; Eckmanns, Tim; Werner, Guido


    Outbreaks of Staphylococcus aureus are common in neonatal intensive care units (NICUs). Usually they are documented for methicillin-resistant strains, while reports involving methicillin-susceptible S. aureus (MSSA) strains are rare. In this study we report the epidemiological and molecular investigation of an MSSA outbreak in a NICU among preterm neonates. Infection control measures and interventions were commissioned by the Local Public Health Authority and supported by the Robert Koch Institute. To support epidemiological investigations molecular typing was done by spa-typing and Multilocus sequence typing; the relatedness of collected isolates was further elucidated by DNA SmaI-macrorestriction, microarray analysis and bacterial whole genome sequencing. A total of 213 neonates, 123 healthcare workers and 205 neonate parents were analyzed in the period November 2011 to November 2012. The outbreak strain was characterized as a MSSA spa-type t021, able to produce toxic shock syndrome toxin-1 and Enterotoxin A. We identified seventeen neonates (of which two died from toxic shock syndrome), four healthcare workers and three parents putatively involved in the outbreak. Whole-genome sequencing permitted to exclude unrelated cases from the outbreak and to discuss the role of healthcare workers as a reservoir of S. aureus on the NICU. Genome comparisons also indicated the presence of the respective clone on the ward months before the first colonized/infected neonates were detected.

  5. A cluster randomised controlled trial of the clinical and cost-effectiveness of a 'whole systems' model of self-management support for the management of long- term conditions in primary care: trial protocol

    Directory of Open Access Journals (Sweden)

    Bower Peter


    Full Text Available Abstract Background Patients with long-term conditions are increasingly the focus of quality improvement activities in health services to reduce the impact of these conditions on quality of life and to reduce the burden on care utilisation. There is significant interest in the potential for self-management support to improve health and reduce utilisation in these patient populations, but little consensus concerning the optimal model that would best provide such support. We describe the implementation and evaluation of self-management support through an evidence-based 'whole systems' model involving patient support, training for primary care teams, and service re-organisation, all integrated into routine delivery within primary care. Methods The evaluation involves a large-scale, multi-site study of the implementation, effectiveness, and cost-effectiveness of this model of self-management support using a cluster randomised controlled trial in patients with three long-term conditions of diabetes, chronic obstructive pulmonary disease (COPD, and irritable bowel syndrome (IBS. The outcome measures include healthcare utilisation and quality of life. We describe the methods of the cluster randomised trial. Discussion If the 'whole systems' model proves effective and cost-effective, it will provide decision-makers with a model for the delivery of self-management support for populations with long-term conditions that can be implemented widely to maximise 'reach' across the wider patient population. Trial registration number ISRCTN: ISRCTN90940049

  6. The Milankovitch theory and climate sensitivity. I - Equilibrium climate model solutions for the present surface conditions. II - Interaction between the Northern Hemisphere ice sheets and the climate system (United States)

    Neeman, Binyamin U.; Ohring, George; Joseph, Joachim H.


    A seasonal climate model was developed to test the climate sensitivity and, in particular, the Milankovitch (1941) theory. Four climate model versions were implemented to investigate the range of uncertainty in the parameterizations of three basic feedback mechanisms: the ice albedo-temperature, the outgoing long-wave radiation-temperature, and the eddy transport-meridional temperature gradient. It was found that the differences between the simulation of the present climate by the four versions were generally small, especially for annually averaged results. The climate model was also used to study the effect of growing/shrinking of a continental ice sheet, bedrock sinking/uplifting, and sea level changes on the climate system, taking also into account the feedback effects on the climate of the building of the ice caps.

  7. Selective conditions for the fabrication of a flexible dye-sensitized solar cell with Ti/TiO{sub 2} photoanode

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Lu-Yin; Lee, Chuan-Pei; Vittal, R. [Department of Chemical Engineering, National Taiwan University, Taipei 10617 (China); Ho, Kuo-Chuan [Department of Chemical Engineering, National Taiwan University, Taipei 10617 (China); Institute of Polymer Science and Engineering, National Taiwan University, Taipei 10617 (China)


    The effects of four factors, i.e., (i) sputter-deposition time of platinum (Pt) film, (ii) sintering temperature of TiO{sub 2}-coated Ti foil (Ti/TiO{sub 2}), (iii) thickness of Ti foil, and (iv) concentration of iodine are reported for the photovoltaic performance of a back-illuminated flexible dye-sensitized solar cell (DSSC) with Ti foil substrate for the TiO{sub 2} layer. Optimization of these four factors yields a solar-to-electricity conversion efficiency ({eta}) of 5.95%. Transmittance spectra, cyclic voltammetry (CV), electrochemical impedance spectra (EIS), X-ray diffraction (XRD), scanning electron micrographs (SEM), and laser-induced photovoltage transient technique are used to substantiate the explanations. (author)

  8. Characterization and sensitivity to antibiotics of bacteria isolated from the lower respiratory tract of ventilated patients hospitalized in intensive care units

    Directory of Open Access Journals (Sweden)

    Manuel Medell


    Full Text Available OBJECTIVE: This observational study described the characterization of bacteria isolated from the lower respiratory tract of ventilated patients hospitalized in intensive care units. The demonstration of isolated microorganism resistance to antibiotics and a time-trend analysis of infection comparing a 48-month period were also other objectives. METHOD: Semi-quantitative assays of 1254 samples taken from 741 ventilated patients were performed, while pathogens were identified using the Enterotube II assay and VITEK 2 Compact equipment. Bacterial resistance to antibiotics was assessed by the Kirby-Bauer disc diffusion method and time-trend analysis of infection was based on data recorded by hospital microbiology laboratories. RESULTS: The most prevalent isolated bacteria from the patient's lower respiratory tract were with Gram-negative bacteria (67.8% mostly represented by: Acinetobacter spp. (25.2%, Pseudomonas spp. (18.3% and Klebsiellas spp. (9.4%. Acinetobacter spp. showed moderate high to very high resistance to ceftriaxone (CRO, gentamicin (CN, amikacin (AK, meropenem (MRP, aztreonam (ATM and piperacillin/tazobactam (TZP. Some isolates of Acinetobacter spp. resistant to colistin (CS were identified in this patient population. Pseudomonas spp. and Klebsiella spp. were very highly resistant to ampicillin/sublactam (AMS and with moderate or low resistance to CRO, ATM, MRP, AK, CN and TZP. A decrease in the Pseudomonas spp. prevalence rate was observed, whereas an increase in Acinetobacter spp. and Klebsiella spp. prevalence rates were observed in a 48-month period. CONCLUSION: This research corroborated that these nosocomial infections are a relevant medical problem in our context. The most prevalent bacterial infections in the lower respiratory tract of ventilated patients were by Acinetobacter spp., Pseudomonas spp. and Klebsiella spp. The panel of antibiotics used as preventive therapy was not the solution of infections and probably induced

  9. Risk-factors for stress-related absence among health care employees: a bio-psychosocial perspective. Associations between self-rated health, working conditions and biological stress hormones

    Directory of Open Access Journals (Sweden)

    Ann-Sophie Hansson


    Full Text Available

    Background: Stress is a major cause of sickness absence and the health care sector appears to be especially at risk. This cross sectional study aimed to identify the risk factors for absence due to self-reported stress among health care employees. Methods: 225 health care employees were categorized into two groups based on presence or not of self-rated sickness absence for stress. Questionnaire data and stress sensitive hormones measurements were used.

    Results: Employees with stress related sick leave experienced worse health, poorer work satisfaction as well as worse social and home situations than those employees without stress-related sick leave. No-significant differences were identified regarding stress-sensitive hormones. The risk for employees, not satisfied at work, of becoming absent due to stress was approximately three fold compared to those who reported being satisfied (OR 2.8, 95% confidence interval; (CI 1.3 - 5.9. For those not satisfied with their social situation, the risk for sickness absence appeared to be somewhat higher (OR 3.2; CI 1.2 - 8.6. Individual factors such as recovery potential and meaning of life as well as work related factors such as skill development and work tempo predicted employee’ s work satisfaction.

    Conclusions: Based on cross sectional data, work-site and individual factors as well as social situations appear to increase the risk for absence due to stress among health care employees. Lower recovery potential, higher work tempo and poor leadership appeared to be related to the high degree of work related exhaustion experienced by employees.

  10. Large-Eddy Simulation Comparison of Neutral Flow Over a Canopy: Sensitivities to Physical and Numerical Conditions, and Similarity to Other Representations (United States)

    Ouwersloot, H. G.; Moene, A. F.; Attema, J. J.; de Arellano, J. Vilà-Guerau


    The representation of a neutral atmospheric flow over roughness elements simulating a vegetation canopy is compared between two large-eddy simulation models, wind-tunnel data and recently updated empirical flux-gradient relationships. Special attention is devoted to the dynamics in the roughness sublayer above the canopy layer, where turbulence is most intense. By demonstrating that the flow properties are consistent across these different approaches, confidence in the individual independent representations is bolstered. Systematic sensitivity analyses with the Dutch Atmospheric Large-Eddy Simulation model show that the transition in the one-sided plant-area density from the canopy layer to unobstructed air potentially alters the flow in the canopy and roughness sublayer. Anomalously induced fluctuations can be fully suppressed by spreading the transition over four steps. Finer vertical resolutions only serve to reduce the magnitude of these fluctuations, but do not prevent them. To capture the general dynamics of the flow, a resolution of 10 % of the canopy height is found to suffice, while a finer resolution still improves the representation of the turbulent kinetic energy. Finally, quadrant analyses indicate that momentum transport is dominated by the mean velocity components within each quadrant. Consequently, a mass-flux approach can be applied to represent the momentum flux.

  11. Predictors of Age of Diagnosis for Children with Autism Spectrum Disorder: The Role of a Consistent Source of Medical Care, Race, and Condition Severity (United States)

    Emerson, Natacha D.; Morrell, Holly E. R.; Neece, Cameron


    Having a consistent source of medical care may facilitate diagnosis of autism spectrum disorders (ASD). This study examined predictors of age of ASD diagnosis using data from the 2011-2012 National Survey of Children's Health. Using multiple linear regression analysis, age of diagnosis was predicted by race, ASD severity, having a consistent…

  12. Nonceliac gluten sensitivity. (United States)

    Fasano, Alessio; Sapone, Anna; Zevallos, Victor; Schuppan, Detlef


    During the past decade there has been an impressive increase in popularity of the gluten-free diet (GFD)-now the most trendy alimentary habit in the United States and other countries. According to recent surveys, as many as 100 million Americans will consume gluten-free products within a year. Operating under the concept that the GFD benefits only individuals with celiac disease, health care professionals have struggled to separate the wheat from the chaff; there are claims that eliminating gluten from the diet increases health and helps with weight loss, or even that gluten can be harmful to every human being. However, apart from unfounded trends, a disorder related to ingestion of gluten or gluten-containing cereals, namely nonceliac gluten sensitivity (NCGS), has resurfaced in the literature, fueling a debate on the appropriateness of the GFD for people without celiac disease. Although there is clearly a fad component to the popularity of the GFD, there is also undisputable and increasing evidence for NCGS. However, we require a better understanding of the clinical presentation of NCGS, as well as its pathogenesis, epidemiology, management, and role in conditions such as irritable bowel syndrome, chronic fatigue, and autoimmunity. Before we can begin to identify and manage NCGS, there must be agreement on the nomenclature and definition of the disorder based on proper peer-reviewed scientific information. We review the most recent findings on NCGS and outline directions to dissipate some of the confusion related to this disorder.

  13. Development, validation and application of a sensitive analytical method for residue determination and dissipation of imidacloprid in sugarcane under tropical field condition. (United States)

    Ramasubramanian, T; Paramasivam, M; Nirmala, R


    A simple and sensitive analytical method has been developed and validated for the determination of trace amounts of imidacloprid in/on sugarcane sett, stalk and leaf. The method optimized in the present study requires less volume of organic solvent and time. Hence, this method is suitable for high-throughput analyses involving large number of samples. The limit of detection (LOD) and limit of quantification (LOQ) of the method were 0.003 and 0.01 mg/kg, respectively. The recovery and relative standard deviation were more than 93 % and less than 4 %, respectively. Thus, it is obvious that the analytical method standardized in this study is more precise and accurate enough to determine the residues of imidacloprid in sugarcane sett, stalk and leaf. The dissipation and translocation of imidacloprid residues from treated cane setts to leaf and stalk were studied by adopting this method. In sugarcane setts, the residues of imidacloprid persisted up to 120 days with half-life of 15.4 days at its recommended dose (70 g a.i./ha). The residues of imidacloprid were found to be translocated from setts to stalk and leaf. The imidacloprid residues were detected up to 105 days in both leaf and stalk. Dipping of sugarcane setts in imidacloprid at its recommended dose may result in better protection of cane setts and established crop because of higher initial deposit (>100 mg/kg) and longer persistence (>120 days).

  14. Sensitivity studies of high-resolution RegCM3 simulations of precipitation over the European Alps: the effect of lateral boundary conditions and domain size (United States)

    Nadeem, Imran; Formayer, Herbert


    A suite of high-resolution (10 km) simulations were performed with the International Centre for Theoretical Physics (ICTP) Regional Climate Model (RegCM3) to study the effect of various lateral boundary conditions (LBCs), domain size, and intermediate domains on simulated precipitation over the Great Alpine Region. The boundary conditions used were ECMWF ERA-Interim Reanalysis with grid spacing 0.75∘, the ECMWF ERA-40 Reanalysis with grid spacing 1.125 and 2.5∘, and finally the 2.5∘ NCEP/DOE AMIP-II Reanalysis. The model was run in one-way nesting mode with direct nesting of the high-resolution RCM (horizontal grid spacing Δx = 10 km) with driving reanalysis, with one intermediate resolution nest (Δx = 30 km) between high-resolution RCM and reanalysis forcings, and also with two intermediate resolution nests (Δx = 90 km and Δx = 30 km) for simulations forced with LBC of resolution 2.5∘. Additionally, the impact of domain size was investigated. The results of multiple simulations were evaluated using different analysis techniques, e.g., Taylor diagram and a newly defined useful statistical parameter, called Skill-Score, for evaluation of daily precipitation simulated by the model. It has been found that domain size has the major impact on the results, while different resolution and versions of LBCs, e.g., 1.125∘ ERA40 and 0.7∘ ERA-Interim, do not produce significantly different results. It is also noticed that direct nesting with reasonable domain size, seems to be the most adequate method for reproducing precipitation over complex terrain, while introducing intermediate resolution nests seems to deteriorate the results.

  15. Multiple chemical sensitivity

    DEFF Research Database (Denmark)

    Tran, Marie Thi Dao; Arendt-Nielsen, Lars; Kupers, Ron;


    BACKGROUND: Multiple Chemical Sensitivity (MCS) is a chronic condition characterized by recurrent, non-specific symptoms in response to chemically unrelated exposures in non-toxic concentrations. Although the pathophysiology of MCS remains unknown, central sensitization may be an important factor...

  16. Effectiveness of a web-based education program to improve vaccine storage conditions in primary care (Keep Cool): study protocol for a randomized controlled trial


    Thielmann, Anika; Viehmann, Anja; Weltermann, Birgitta M


    Background Immunization programs are among the most effective public health strategies worldwide. Adequate vaccine storage is a prerequisite to assure the vaccines’ effectiveness and safety. In a questionnaire survey among a random sample of German primary care physicians, we discovered vaccine storage deficits: 16 % of physicians had experience with cold chain breaches either as an error or near error, 49 % did not keep a temperature log, and 21 % did not use a separate refrigerator for vacc...

  17. Implementing, embedding and integrating self-management support tools for people with long-term conditions in primary care nursing: a qualitative study\\ud


    Kennedy, Anne; Rogers, Anne; Bowen, Robert; Lee, Victoria; Blakeman, Tom; Gardner, Caroline; Morris, Rebecca; Protheroe, Joanne; Chew-Graham, Carolyn


    Background\\ud \\ud An implementation gap exists between policy aspirations for provision and the delivery of self-management support in primary care. An evidence based training and support package using a whole systems approach implemented as part of a randomised controlled trial was delivered to general practice staff. The trial found no effect of the intervention on patient outcomes. This paper explores why self-management support failed to become part of normal practice. We focussed on impl...

  18. Freqüência à creche e outros condicionantes do estado nutricional infantil Attendance at day-care centers and other conditioning factors in child nutritional status

    Directory of Open Access Journals (Sweden)

    Marina Vieira da Silva


    Full Text Available O estudo descreve o estado nutricional de 2 096 pré-escolares atendidos nos 27 Centros Educacionais e Creches do município de Piracicaba, estado de São Paulo. Observa-se que 5,1% das crianças apresentam déficit de altura/idade (escore ZAI The study describes the nutritional status of 2 096 preschool children attending 27 Educational Centers and Day-Care Centers in Piracicaba, state of São Paulo. Five point one percent of the children are observed to present a height/age deficit (score HAZ<-2.0 and a proportion of 1.2 with weight/height deficit (score WHZ<-2.0. The results reveal that per capita income, mother schooling, type of sewage, type of housing and attendance time at are the variables that cause impact on the HAZ score of the children.The positive association detected between attendance time at and -Z score of height for age stresses the importance of these investments as means to protect children, mainly against chronic malnutrition, as basic care with health, feeding and hygiene is associated with education. The day-care center also provides the participation of mothers in the work market, which is very important in poor families in order to increase family income.

  19. Optimization of the operating conditions of solid sampling electrothermal vaporization coupled to inductively coupled plasma optical emission spectrometry for the sensitive direct analysis of powdered rice. (United States)

    Sadiq, Nausheen; Beauchemin, Diane


    Two different approaches were used to improve the capabilities of solid sampling (SS) electrothermal vaporization (ETV) coupled to inductively coupled plasma optical emission spectrometry (ICP-OES) for the direct analysis of powdered rice. Firstly, a cooling step immediately before and after the vaporization step in the ETV temperature program resulted in a much sharper analyte signal peak. Secondly, point-by-point internal standardization with an Ar emission line significantly improved the linearity of calibration curves obtained with an increasing amount of rice flour certified reference material (CRM). Under the optimized conditions, detection limits ranged from 0.01 to 6ngg(-1) in the solid, depending on the element and wavelength selected. The method was validated through the quantitative analysis of corn bran and wheat flour CRMs. Application of the method to the multi-elemental analysis of 4-mg aliquots of real organic long grain rice (white and brown) also gave results for Al, As, Co, Cu, Fe, Mg, Se, Pb and Zn in agreement with those obtained by inductively coupled plasma mass spectrometry following acid digestion of 0.2-g aliquots. As the analysis takes roughly 5min per sample (2.5min for grinding, 0.5-1min for weighing a 4-mg aliquot and 87s for the ETV program), this approach shows great promise for fast screening of food samples.

  20. Critical Care (United States)

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications ... a team of specially-trained health care providers. Critical care usually takes place in an intensive care ...

  1. Tracheostomy care (United States)

    Respiratory failure - tracheostomy care; Ventilator - tracheostomy care; Respiratory insufficiency - tracheostomy care ... Before you leave the hospital, health care providers will teach you how ... and suction the tube Keep the air you breathe moist Clean ...

  2. Sensitivity analysis (United States)

    ... page: // Sensitivity analysis To use the sharing features on this page, please enable JavaScript. Sensitivity analysis determines the effectiveness of antibiotics against microorganisms (germs) ...

  3. Preparing the Pediatric Dentist for Palliative and End-of-life Care. (United States)

    Sarvas, Elise W; Schwantes, Scott A; Karp, Jeffrey M


    Pediatric dentists are the primary providers of dental homes for children with life-threatening and complex chronic conditions. These children are increasingly living at home and seeking health care in community-based settings, including dental offices. Pediatric dentists may feel ill prepared to assume the roles and responsibilities of a pediatric palliative care provider due to limited education and training during dental school and residency; however, they should be sensitive to the palliative care needs of children and families. The purpose of this clinical article was to highlight palliative care scenarios in pediatric dentistry and provide actionable resources to empower pediatric dentists to gather health care information, make informed ethical decisions, promote patient- and family-centered care, and prepare dentists and their dental teams for episodes of death and bereavement when providing a dental home to patients with life-threatening and complex chronic conditions.

  4. Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings – Guideline of the German Society for Hospital Hygiene (DGKH) (United States)

    Külpmann, Rüdiger; Christiansen, Bärbel; Kramer, Axel; Lüderitz, Peter; Pitten, Frank-Albert; Wille, Frank; Zastrow, Klaus-Dieter; Lemm, Friederike; Sommer, Regina; Halabi, Milo


    Since the publication of the first “Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems) in hospitals” ( in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section “Ventilation and air conditioning technology” attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care. PMID:26958457

  5. Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings - Guideline of the German Society for Hospital Hygiene (DGKH). (United States)

    Külpmann, Rüdiger; Christiansen, Bärbel; Kramer, Axel; Lüderitz, Peter; Pitten, Frank-Albert; Wille, Frank; Zastrow, Klaus-Dieter; Lemm, Friederike; Sommer, Regina; Halabi, Milo


    Since the publication of the first "Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems) in hospitals" ( in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section "Ventilation and air conditioning technology" attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care.

  6. Estado de salud y utilización de recursos sanitarios de una población de ancianos atendidos en domicilio Health conditions and use of social care resources in a population of the elderly taken care at home

    Directory of Open Access Journals (Sweden)

    Carmen Gálvez-Romero


    Full Text Available La población de personas mayores, respecto a la población general en España, representa un 15,4%, proporción que aumentará en el futuro, sobre todo en mayores de 80 años. La atención domiciliaria de esta población es alternativa a su institucionalización, por lo que interesa conocer sus características sociodemográficas, clínicas y de utilización de recursos sanitarios para responder a sus necesidades reales. Se realizó un estudio de corte transversal en pacientes incluidos en un programa de incapacitados. Se estudiaron variables sociodemográficas y clínicas, capacidad funcional y cognitiva, y utilización de recursos sociosanitarios. Nuestros pacientes son una población mayor, presentan deterioro cognitivo importante, nivel elevado de dependencia y comorbilidad. Una quinta parte considera su estado de salud como malo. Utilizan con frecuencia los servicios de urgencia y, en menor medida, ingresan en el hospital. Algunas características sociodemográficas de estos pacientes determinan su nivel de audición y estado mental, tales como la edad, ocupación en su etapa laboral e ingresos económicos. Se mostraron determinantes de la utilización de los servicios sanitarios las patologías crónicas, la polifarmacia, escasamente las incapacidades funcionales y los ingresos económicos.Older persons represent 15,4% of the population of Spain. This proportion will increase in the future, especially for persons older than 80 years of age. As home care for this population is an alternative to their institutionalization, it is necessary to determine their sociodemographic and clinical characteristics, as well as their use of health care resources, in order to respond to their true needs. We undertook a cross-sectional study of patients included in an Incapacity Program. Variables studied included sociodemographic and clinical factors, functional and cognitive capacity, and the use of health and social care resources. The patients were

  7. Conditions, components and outcomes of Integrative Validation Therapy in a long-term care facility for people with dementia. A qualitative evaluation study. (United States)

    Erdmann, Anke; Schnepp, Wilfried


    In this study, the practical application of Integrative Validation Therapy (IVA) in a nursing home for people with dementia was investigated and evaluated from the perspectives of professionals and relatives by using Fourth Generation Evaluation. IVA, a complex intervention frequently applied in Germany's long-term care settings, is a modification of Feil's Validation Therapy and contains a specific attitude and several components of action. The findings demonstrate that professionals as well as relatives of nursing home residents gave the intervention a positive rating. From the perspective of the participating professionals, the application of IVA results in less agitated residents which also has an influence on the consumption of benzodiazepine and neuroleptics. The authors conclude that IVA is a beneficial nursing intervention helping to facilitate the illness-related transition process of people with dementia. IVA is able to support them to cope with emotional distress during transition (e.g. irritability, anxiety, depression, changes in self-esteem). Another conclusion is that IVA supports person-centred care because, with IVA, professionals react to typical needs people with dementia have: comfort, inclusion, attachment and identity (Kitwood, 2012).

  8. Working conditions, health and productivity among dentists in Swedish public dental care - a prospective study during a 5-year period of rationalisation

    DEFF Research Database (Denmark)

    Rolander, B.; Jonker, D.; Winkel, Jørgen;


    patients per dentist increased, and perceived physical working conditions improved while perceived work control and leadership deteriorated. Structural equation modelling showed that physical factors were important for health and productivity. When assessing risks in the work environment, there is a need...... that the present rationalisations resulted in improved perceived physical working conditions. Aspects of the psychosocial working environment had deteriorated, however. This is a concern as health and workability are important for workplace efficiency. © 2013 Copyright Taylor and Francis Group, LLC....

  9. 神经内科重症监护病房病原菌分布及药敏分析%Characteristic Description and Drug Sensitivity Testing of Pathogenic Bacteria in Neurological Intensive Care Unit

    Institute of Scientific and Technical Information of China (English)

    李海英; 李淑娟; 胡文立; 秦伟


    Objective The characteristic of infection strains and the changes in antibiotic-resistance in neurological intensive care unit(NICU) were investigated to direct the antibiotics clinical application, and to reduce the hospital infection incidence rates. Methods From Sep. 2008 to May 2010,451 species from 216 patients in N1CU, including sputum, urine, stools, and blood, were cultured for bacteria identification and drug sensitivity testing. Results Among the isolated 399 strains of pathogenic bacteria,Gram-negative bacilli,Gram-positive cocci and fungi, were 140,73 and 186, respectively. The pathogens were mainly from respiratory tract. As the major pathogens, Candida albicans and Staphylococcus aureu accounted for 49.9% of all pathogens. The results of drug sensitivity testing showed that fungi had great clinical drug resistance; MRSA showed high sensitivity to Glyco-peptides-type drugs;and Gram-negative bacilli showed sensitivity to Carbapenem-type drugs. Cephalosporin-type and Penicillin-type drugs showed different sensitivities to the Gram-negative bacilli. Conclusion The main pathogenic bacteria of NICU were fungi and Gram-negative bacilli, which might be the contribution of extensive use of broad-spectrum antibiotics. The doctors should pay attention to reduce the use of broad-spectrum antibiotics,appropriately increase the use of Glycopeptides-type and Carbapenem-type drugs. Cefoperazone/sulbactam or ceftazidime was suggested as the conventional antiseptic drug.%目的 调查神经内科重症监护病房(NICU)感染患者的病原菌分布及耐药情况,以指导临床抗菌药物的应用,降低医院感染率.方法 对2008年9月-2010年5月期间入住NICU的216例患者送检的痰、尿、便、血等451份标本进行病原菌鉴定和体外药敏试验.结果检出的399株病原菌中,G-杆菌140株,G+球菌73株,真菌186株.病原菌主要采自于呼吸道.致病菌简单且集中,白色念珠菌和MRSA占所有致病菌的49.9%.药敏结果

  10. Abscisic Acid and Cytokinin-Induced Osmotic and Antioxidant Regulation in Two Drought-Tolerant and Drought-Sensitive Cultivars of Wheat During Grain Filling Under Water Deficit in Field Conditions

    Directory of Open Access Journals (Sweden)



    Full Text Available Phytohormones play critical roles in regulating plant responses to stress. The present study investigates the effect of cytokinin, abscisic acid and cytokinin/abscisic acid interaction on some osmoprotectants and antioxidant parameters induced by drought stress in two wheat cultivars (Triticum aestivum L. of ‘Pishgam’ and ‘MV-17’ as tolerant and sensitive to drought during post-anthesis phase, respectively grown in field conditions. The most considerable effect of the treatments was exhibited 21 days after anthesis. Under drought conditions, the flag leaf soluble carbohydrate content increased in both cultivars while starch content was remarkably decreased in ‘Pishgam’ as compared to ‘MV-17’. Abscisic acid increased total soluble sugar and reduced starch more than other hormonal treatments, although it decreased studied monosaccharaides in ‘Pishgam’, especially. Drought stress induced high proportion of gylycinebetain and free proline in ‘Pishgam’ cultivar. Application of abscisic acid and cytokinin/abscisic acid interaction increased gylycinebetain and proline content in both cultivars under irrigation and drought conditions. The tolerant cultivar exhibited less accumulation of hydrogen peroxide and malondialdehyde in relation to significant increase of catalase and peroxidase activities and α-tocpherol content under drought conditions. All hormonal treatments increased the named enzyme activities under both irrigation and drought conditions, while higher accumulation of α-tocopherol was only showed in case of cytokinin application. Also, abscisic acid and cytokinin/abscisic acid could decrease drought-induced hydrogen peroxide and malondialdehyde level to some extent, although abscisic acid increased both of hydrogen peroxide andmalondialdehyde content in irrigation phase, especially.

  11. The Epital Care Model

    DEFF Research Database (Denmark)

    Phanareth, Klaus; Vingtoft, Søren; Christensen, Anders Skovbo


    and organizations that provide health care. Technology may be a way to enable the creation of a coherent, cocreative, person-centered method to provide health care for individuals with one or more long-term conditions (LTCs). It remains to be determined how a new care model can be introduced that supports...... the intentions of the World Health Organization (WHO) to have integrated people-centered care. OBJECTIVE: To design, pilot, and test feasibility of a model of health care for people with LTCs based on a cocreative, iterative, and stepwise process in a way that recognizes the need for person-centered care...... and face-to-face support for COPD management. In step five the initial model was extended with elements that support continuity of care. Beginning in the autumn of 2013, 1102 frail elderly individuals were included and offered two additional services: an outgoing acute medical team and a local subacute bed...

  12. On conditions and parameters important to model sensitivity for unsaturated flow through layered, fractured tuff; Results of analyses for HYDROCOIN [Hydrologic Code Intercomparison Project] Level 3 Case 2: Yucca Mountain Project

    Energy Technology Data Exchange (ETDEWEB)

    Prindle, R.W.; Hopkins, P.L.


    The Hydrologic Code Intercomparison Project (HYDROCOIN) was formed to evaluate hydrogeologic models and computer codes and their use in performance assessment for high-level radioactive-waste repositories. This report describes the results of a study for HYDROCOIN of model sensitivity for isothermal, unsaturated flow through layered, fractured tuffs. We investigated both the types of flow behavior that dominate the performance measures and the conditions and model parameters that control flow behavior. We also examined the effect of different conceptual models and modeling approaches on our understanding of system behavior. The analyses included single- and multiple-parameter variations about base cases in one-dimensional steady and transient flow and in two-dimensional steady flow. The flow behavior is complex even for the highly simplified and constrained system modeled here. The response of the performance measures is both nonlinear and nonmonotonic. System behavior is dominated by abrupt transitions from matrix to fracture flow and by lateral diversion of flow. The observed behaviors are strongly influenced by the imposed boundary conditions and model constraints. Applied flux plays a critical role in determining the flow type but interacts strongly with the composite-conductivity curves of individual hydrologic units and with the stratigraphy. One-dimensional modeling yields conservative estimates of distributions of groundwater travel time only under very limited conditions. This study demonstrates that it is wrong to equate the shortest possible water-travel path with the fastest path from the repository to the water table. 20 refs., 234 figs., 10 tabs.

  13. Child Care Centres. (United States)

    Australian Dept. of Labour and National Service, Melbourne. Women's Bureau.

    Based on a survey of legislation relating to full-day care for preschool children of working mothers and a study of records, this report: (1) covers the number of registered child care centers in Australia and the number of children being served, (2) sets the conditions applying to registration of centers, (3) indicates the extent and levels of…

  14. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules. (United States)


    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2013. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes that were applied to the LTCH PPS by the Affordable Care Act. Generally, these updates and statutory changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or have revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. In addition, we are revising the conditions of participation (CoPs) for hospitals relating to the

  15. Personal Care in Learning Health Care Systems. (United States)

    Miller, Franklin G; Kim, Scott Y H


    The idea of a "learning health care system"--one that systematically integrates clinical research with medical care--has received considerable attention recently. Some commentators argue that under certain conditions pragmatic comparative effectiveness randomized trials can be conducted ethically within the context of a learning health care system without the informed consent of patients for research participation. In this article, we challenge this perspective and contend that conducting randomized trials of individual treatment options without consent is neither necessary nor desirable to promote and sustain learning health care systems. Our argument draws on the normative conception of personal care developed by Charles Fried in a landmark 1974 book on the ethics of randomized controlled trials.

  16. Hospice Care (United States)

    Hospice care is end-of-life care. A team of health care professionals and volunteers provides it. ... can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient's ...

  17. Palliative Care (United States)

    Palliative care is treatment of the discomfort, symptoms, and stress of serious illness. It provides relief from distressing symptoms ... of the medical treatments you're receiving. Hospice care, care at the end of life, always includes ...

  18. Cues of maternal condition influence offspring selfishness.

    Directory of Open Access Journals (Sweden)

    Janine W Y Wong

    Full Text Available The evolution of parent-offspring communication was mostly studied from the perspective of parents responding to begging signals conveying information about offspring condition. Parents should respond to begging because of the differential fitness returns obtained from their investment in offspring that differ in condition. For analogous reasons, offspring should adjust their behavior to cues/signals of parental condition: parents that differ in condition pay differential costs of care and, hence, should provide different amounts of food. In this study, we experimentally tested in the European earwig (Forficula auricularia if cues of maternal condition affect offspring behavior in terms of sibling cannibalism. We experimentally manipulated female condition by providing them with different amounts of food, kept nymph condition constant, allowed for nymph exposure to chemical maternal cues over extended time, quantified nymph survival (deaths being due to cannibalism and extracted and analyzed the females' cuticular hydrocarbons (CHC. Nymph survival was significantly affected by chemical cues of maternal condition, and this effect depended on the timing of breeding. Cues of poor maternal condition enhanced nymph survival in early broods, but reduced nymph survival in late broods, and vice versa for cues of good condition. Furthermore, female condition affected the quantitative composition of their CHC profile which in turn predicted nymph survival patterns. Thus, earwig offspring are sensitive to chemical cues of maternal condition and nymphs from early and late broods show opposite reactions to the same chemical cues. Together with former evidence on maternal sensitivities to condition-dependent nymph chemical cues, our study shows context-dependent reciprocal information exchange about condition between earwig mothers and their offspring, potentially mediated by cuticular hydrocarbons.

  19. Crossing the caring chasm

    DEFF Research Database (Denmark)

    Kitson, Alison; Sørensen, Erik Elgaard


    upon prevention and screening, the trend will continue to be around providing care and support for individuals, families and communities for chronic and life-style induced diseases. The emphasis will therefore be on the need for evidence-based care as much as evidence-based medicine (or cure......). By definition, patients with chronic conditions cannot be cured; this means their fundamental care needs are at the centre of their course of care and hence, nursing (Henderson 1966). This article is protected by copyright. All rights reserved....

  20. The emotional overlay: older person and carer perspectives on negotiating aging and care in rural Ontario. (United States)

    Herron, Rachel V; Skinner, Mark W


    This paper extends the burgeoning interest in emotion, health and place by investigating the emotionally complex experiences of aging and care in rural settings. Featuring a thematic analysis of 44 semi-structured interviews and two focus groups with older people and their carers in rural Ontario (Canada) we examine the importance and implications of emotions within and across multiple scales at which care relationships, expectations and responsibilities are negotiated. With the aim of broadening the discussion surrounding geographical dimensions of ethical care, our approach draws on feminist care ethics to understand the multifaceted ways in which emotions shape and are shaped by experiences of aging and caring at the interpersonal, household and community scales. The findings reveal how emotions are central, yet often-overlooked and even hidden within care relationships among older rural people and their carers. We argue that ethical care is contingent on recognizing and valuing the situated emotions involved in doing care work, sustaining care relationships and asking for care. In doing so, we demonstrate how qualitative research on the emotional geographies of care can contribute to the development of informed policies that are contextually sensitive and, ultimately, have the potential to build more ethical rural conditions of care.

  1. Climate Sensitivity

    Energy Technology Data Exchange (ETDEWEB)

    Lindzen, Richard [M.I.T.


    Warming observed thus far is entirely consistent with low climate sensitivity. However, the result is ambiguous because the sources of climate change are numerous and poorly specified. Model predictions of substantial warming aredependent on positive feedbacks associated with upper level water vapor and clouds, but models are notably inadequate in dealing with clouds and the impacts of clouds and water vapor are intimately intertwined. Various approaches to measuring sensitivity based on the physics of the feedbacks will be described. The results thus far point to negative feedbacks. Problems with these approaches as well as problems with the concept of climate sensitivity will be described.

  2. [Surgical Center environment and its elements: implications for nursing care]. (United States)

    Silva, Denise Conceição; Alvim, Neide Aparecida Titonelli


    The purpose of this qualitative research was to characterize the elements that constitute the environment of the Surgical Center and to analyze its implications for dynamic of care and nursing care. Based on the Environmental Theory's principals. Participated twelve nurses from the Surgical Center of a College Hospital in Rio de Janeiro. Data were gathered through the creativity and sensitivity technique "Map-Speaker", semi-structered interviews and participant observation, and were analyzed by thematic categories. The results showed that care can happen directly and indirectly in favor of full client recovery, counting the environment that the integrate in purpose to maintain harmonic and balanced. The nurse interventions aim to maintain the environment in favorable conditions so that a higher standard of care can be promoted.

  3. Gluten Sensitivity (United States)

    ... in other products like medicines, vitamins, and supplements. People with gluten sensitivity have problems with gluten. It is different from celiac disease, an immune disease in which people can't eat gluten because it will damage ...

  4. Palliative Care (United States)

    ... you are a partner with the palliative care team as you all work toward the same goal — providing the best quality of life for your child for as ... Care for Children With Terminal Illness Managing Home Health Care Taking Care of You: Support ...

  5. Hospice care (United States)

    ... family a break (called respite care). Doctor services. Nursing care. Home health aide and homemaker services. Counseling. Medical ... may be given in other locations, including: A nursing home A ... in charge of care is called the primary care giver. This may ...

  6. These Shoes Are Made for Walking: Sensitivity Performance Evaluation of Commercial Activity Monitors under the Expected Conditions and Circumstances Required to Achieve the International Daily Step Goal of 10,000 Steps.

    Directory of Open Access Journals (Sweden)

    Sandra O'Connell

    Full Text Available Physical activity is a vitally important part of a healthy lifestyle, and is of major benefit to both physical and mental health. A daily step count of 10,000 steps is recommended globally to achieve an appropriate level of physical activity. Accurate quantification of physical activity during conditions reflecting those needed to achieve the recommended daily step count of 10,000 steps is essential. As such, we aimed to assess four commercial activity monitors for their sensitivity/accuracy in a prescribed walking route that reflects a range of surfaces that would typically be used to achieve the recommended daily step count, in two types of footwear expected to be used throughout the day when aiming to achieve the recommended daily step count, and in a timeframe required to do so.Four commercial activity monitors were worn simultaneously by participants (n = 15 during a prescribed walking route reflective of surfaces typically encountered while achieving the daily recommended 10,000 steps. Activity monitors tested were the Garmin Vivofit ™, New Lifestyles' NL-2000 ™ pedometer, Withings Smart Activity Monitor Tracker (Pulse O2 ™, and Fitbit One ™.All activity monitors tested were accurate in their step detection over the variety of different surfaces tested (natural lawn grass, gravel, ceramic tile, tarmacadam/asphalt, linoleum, when wearing both running shoes and hard-soled dress shoes.All activity monitors tested were accurate in their step detection sensitivity and are valid monitors for physical activity quantification over the variety of different surfaces tested, when wearing both running shoes and hard-soled dress shoes, and over a timeframe necessary for accumulating the recommended daily step count of 10,000 steps. However, it is important to consider the accuracy of activity monitors, particularly when physical activity in the form of stepping activities is prescribed as an intervention in the treatment or prevention of a

  7. Psychiatric care in restricted conditions for work migrants, refugees and asylum seekers: experience of the Open Clinic for Work Migrants and Refugees, Israel 2006. (United States)

    Lurie, Ido


    In the last few decades, the State of Israel has become a target for work migrants, refugees, asylum seekers and victims of human trafficking, as part of the trend of world immigration. Immigration is a process of loss and change with significant socio-psychological stress, with possible effects on the immigrants' mental health. The Physicians for Human Rights - Israel (PHR) Association operates a psychiatric clinic as part of the Open Clinic for Work Migrants and Refugees. This article will present major clinical issues regarding psychiatry and immigration in Israel according to the data collected at the clinic. Trauma and stress-related psychopathology was found to have a high prevalence in immigrant patients treated at the clinic; prevalence of PTSD (post-traumatic stress disorder) in immigrants was high (23%) and even higher in refugees (33%). Female immigrants are at higher risk for psychiatric hospitalization. The relative rate of African patients at the clinic is significantly higher than patients from other continents. A significant association was found between psychiatric hospitalization and suicide attempts. Immigrant patients present a combination of psychiatric, socio-economic and general medical conditions, which demands a holistic view of the patient. The evaluation of an immigrant patient must take into account the stress related to immigration, gender, culture of origin and the risk for suicide and hospitalization. Treatment recommendations include awareness of cultural diversities, acquiring information regarding the pre-immigration history, preferably using cultural consultants with background in the immigrants' culture and community. Decision-making about medication and diagnostic evaluation should be as inexpensive as possible. Basic human needs (food, shelter) and family support should be included in the decisions about treatment.

  8. Beyond Care Avoidance and Care Paralysis : Theorizing Public Mental Health Care

    NARCIS (Netherlands)

    Schout, Gert; de Jong, Gideon; Zeelen, Jacques


    Care avoidance refers to the condition wherein clients do not seek assistance and do not attend appointments although they are in need of help. Care avoidance is linked to another phenomenon, the inability to help clients with multiple and complex problems by social services and care facilities, in

  9. Path Sensitization

    Institute of Scientific and Technical Information of China (English)

    赵著行; 闵应骅; 等


    For different delay models,the concept of sensitization can be very different.Traditonal concepts of sensitization cannot precisely describe circuit behavior when the input vectors change very fast.Using Boolean process aporoach,this paper presents a new definition of sensitization for arbitrary input waveforms.By this new concept it is found that if the inputs of a combinational circuit can change at any time,and each gate's delay varies within an interval (bounded gate delay model),then every path,which is not necessarily a single topological path,is sensitizable.From the experimental results it can be seen that,all nonsensitizable paths for traditional concepts actually can propagate transitions along them for some input waveforms.However,specified time between input transitions(STBIT) and minimum permissible pulse width(ε)are two major factors to make some paths non-sensitizable.

  10. A multilevel study on the association of observer-assessed working conditions with depressive symptoms among female eldercare workers from 56 work units in 10 care homes in Denmark

    DEFF Research Database (Denmark)

    Jakobsen, Louise M.; Jorgensen, Anette F. B.; Thomsen, Birthe L.


    workers. METHODS: Working conditions were observed based on action regulation theory and defined as (1) regulation requirements, a workplace resource providing opportunity for decision-making and skill development and (2) barriers for task completion. We examined the associations of individual and work......-observed individuals. We used regression models that allowed for correlations within work units and care homes and adjusted these models for demographics, job characteristics and stressful life events. RESULTS: Higher levels of regulation requirements were associated with lower depressive symptoms at the individual...... level (p=0.04), but not at the workplace level. Barriers were not associated with depressive symptoms at the individual level. At the workplace level, a higher number of qualitatively different barriers (p=0.04) and a higher number of barriers for equipment use (p=0.03) were associated with lower levels...

  11. Point of care testing: diagnosis outside the virology laboratory. (United States)

    Blyth, Christopher C; Booy, Robert; Dwyer, Dominic E


    Numerous point-of-care tests (POCTs) are available to diagnose viral infections in both hospital and community settings. The ideal POCT is rapid, sensitive, specific, and simple to perform. This chapter will describe the benefits of POCTs, factors that can influence the accuracy of POCTs and highlight some limitations of POCT strategies. The sensitivity, specificity, and turn-around time of available POCTs are included for common conditions including respiratory viral infections (e.g. influenza, RSV) and blood-borne viral infections (e.g. HIV).

  12. Sensitivity of Complex Networks

    CERN Document Server

    Angulo, Marco Tulio; Liu, Yang-Yu; Barabási, Albert-László


    The sensitivity (i.e. dynamic response) of complex networked systems has not been well understood, making difficult to predict whether new macroscopic dynamic behavior will emerge even if we know exactly how individual nodes behave and how they are coupled. Here we build a framework to quantify the sensitivity of complex networked system of coupled dynamic units. We characterize necessary and sufficient conditions for the emergence of new macroscopic dynamic behavior in the thermodynamic limit. We prove that these conditions are satisfied only for architectures with power-law degree distributions. Surprisingly, we find that highly connected nodes (i.e. hubs) only dominate the sensitivity of the network up to certain critical frequency.

  13. [Home care in Sapporo]. (United States)

    Yazaki, Kazuo


    We established a clinic specialized in home care in Sapporo in July 2001. In these 2 years we have provided medical home care service to 160 patients, and 97 are still receiving regular service. At first we accepted any patients living within 16 km from the clinic. However, bad traffic conditions in winter made it difficult to visit patients living in districts far away from the clinic. Therefore, we planned a network of home care physicians in Sapporo. Now 12 home care physicians hold monthly meetings. In Sapporo, meetings of home care related workers are organized in each ward, as suggested by the Sapporo Medical Association. There is a relatively good supply of home care related services and resources, including availability of an important number of visiting nurses. Patients being taken care of at home who present an acute exacerbation of symptoms are relatively easily accepted by acute hospitals. But those who have difficulties in continuing home care due to a sudden change in family conditions are not easily accepted by nursing hospitals. Recently, the number of group homes and lodging houses for elderly persons has markedly increased in Sapporo. It might have some problems in medical support in the near future.

  14. The glucagon-like peptide 1 analogue Exendin-4 attenuates the nicotine-induced locomotor stimulation, accumbal dopamine release, conditioned place preference as well as the expression of locomotor sensitization in mice.

    Directory of Open Access Journals (Sweden)

    Emil Egecioglu

    Full Text Available The gastrointestinal peptide glucagon-like peptide 1 (GLP-1 is known to regulate consummatory behavior and is released in response to nutrient ingestion. Analogues of this peptide recently emerged as novel pharmacotherapies for treatment of type II diabetes since they reduce gastric emptying, glucagon secretion as well as enhance glucose-dependent insulin secretion. The findings that GLP-1 targets reward related areas including mesolimbic dopamine areas indicate that the physiological role of GLP-1 extends beyond food intake and glucose homeostasis control to include reward regulation. The present series of experiments was therefore designed to investigate the effects of the GLP-1 receptor agonist, Exendin-4 (Ex4, on established nicotine-induced effects on the mesolimbic dopamine system in mice. Specifically, we show that treatment with Ex4, at a dose with no effect per se, attenuate nicotine-induced locomotor stimulation, accumbal dopamine release as well as the expression of conditioned place preference in mice. In accordance, Ex4 also blocks nicotine-induced expression of locomotor sensitization in mice. Given that development of nicotine addiction largely depends on the effects of nicotine on the mesolimbic dopamine system these findings indicate that the GLP-1 receptor may be a potential target for the development of novel treatment strategies for nicotine cessations in humans.

  15. Visualising Deteriorating Conditions

    Directory of Open Access Journals (Sweden)

    Tom Andrews, RN, B.Sc. (Hons, M.Sc., Ph.D.


    Full Text Available The research aims were to investigate the difficulties ward staff experienced in detecting deterioration and how these were resolved. The emphasis within the literature tends to be on identifying premonitory signs that may be useful in predicting deterioration. Changes in respiratory rate is the most consistent of these (Fieselmann et al. 1993; Sax and Charlson 1987; Schein et al. 1990; Smith and Wood 1998 but in common with other signs, it lacks sensitivity and specificity. The sample consisted of 44 nurses, doctors (Interns and health care support workers from a general medical and surgical ward. Data were collected by means of nonparticipant observations and interviews, using grounded theory as originated by (Glaser and Strauss 1967 and (Glaser 1978. As data were collected, the constant comparative method and theoretical sensitivity were used as outlined in grounded theory. A core category of “visualising deteriorating conditions” emerged, together with its sub-core categories of “intuitive knowing”, “baselining” and “grabbing attention”.The main concern in visualising deteriorating conditions is to ensure that patients suspected of deterioration are successfully referred to medical staff. The aim is to convince those who can treat or prevent further deterioration to intervene. Through intuitive knowing they pick up that patients have changed in a way that requires a medical assessment. To make the referral more credible, nurses attempt to contextualise any changes in patients by baselining (establishing baselines. Finally with the backup of colleagues, nurses refer patients by providing as much persuasive information as possible in a way that grabs attention. The whole process is facilitated by knowledge and experience, together with mutual trust and respect.

  16. Pin care (United States)

    ... gov/pubmed/24302374 . Nagy K. Discharge instructions for wound cares. The American Association of the Surgery of Trauma. . Accessed May 13, 2016.

  17. Palliative Care (United States)

    ... possessions to others, write a letter or a poem or compose a song, or decide what they ... One Year Off Treatment Transitioning to Adult Care Long-Term Follow-Up Care Coping With Cancer Overview ...

  18. Agencia de autocuidado y factores básicos condicionantes en adultos mayores Autocuidado e fatores básicos condicionantes em adultos maiores Self-care agency and basic conditioning factors in the elderly

    Directory of Open Access Journals (Sweden)

    Alba Rosa Fernández


    participacao de 240 adultos maiores, feito em julho de 2009. A Escala ASA foi utilizada para valorar a capacidade de autocuidado e a ficha de dados sócio-demográficos e de saúde (DSDS. Os dados foram analisados no SPSS, versao 15.0. Resultados: A média total ASA dos adultos maiores foi de 46,8; mostrando um desvio padrao de 4,6. 99,6% da populacao apresentaram uma "baixa capacidade do autocuidado", numa faixa de 24 a 59 pontos. A média de idade foi de 71,6 anos; o desvio padrao foi de 6,7; 48,8% da populacao pertenciam á faixa etária de 60-70 anos; 76,7% eram mulheres, 49,2% nao tinham educacao escolar; 42,5% eram viúvos, 70,4% trabalhavam como empregados domésticos; 53,3% pertenciam ao estrato social 1; 73,8% moravam com as suas famílias. 21,7% estavam afiliados ao Caprecom. 23,8% apresentaram problemas renais; 71,3% reportaram deficiencias visuais; 78,3% apresentavam uma média de tensao arterial normal e 84,2% apresentavam um pulso normal. 72% das femeas da populacao apresentam um diámetro abdominal que as poe em risco (mais de 80 cm. Conclusáo: Os adultos maiores apresentaram umabaixa capacidade de autocuidado e dos fatores básicos condicionantes que precisam da atencao da enfermaria.Self-care agency is the capacity of an individual to take care of him/ herself; elements of the individual or the environment he/she lives in may have influence, these are called basic conditioning factors. Purpose: To determine the self-care agency and basic conditioning factors in old patients with hypertension in Tunja, Boyacá, Colombia. Methods: Descriptive cross section study with 240 senior patients carried out in July 2009. ASA scale was used to assess self-care agency and the social-demographic and health data card (DSDS. Data were analyzed in SPSS, version 15.0. Results: The total ASA mean of seniors was 46,8, standard deviation of 4,6; 99,6% showed "low self-care agency", within a range of 24 to 59 points. Average age was 71,6, standard deviation of 6,7; 48,8% were

  19. Comparing Care

    NARCIS (Netherlands)

    Evert Pommer; Isolde Woittiez; John Stevens


    Home care is one of the most important means of compensating for disabilities and ensuring continuity in people's daily functioning. Home care services in the Netherlands have recently been transferred from a national social security provision for long-term care to a local social service. In most ot

  20. Sensitive innovation

    DEFF Research Database (Denmark)

    Søndergaard, Katia Dupret

    Present paper discusses sources of innovation as heterogenic and at times intangible processes. Arguing for heterogeneity and intangibility as sources of innovation originates from a theoretical reading in STS and ANT studies (e.g. Callon 1986, Latour 1996, Mol 2002, Pols 2005) and from field work...... in the area of mental health (Dupret Søndergaard 2009, 2010). The concept of sensitive innovation is developed to capture and conceptualise exactly those heterogenic and intangible processes. Sensitive innovation is therefore primarily a way to understand innovative sources that can be......, but are not necessarily, recognized and acknowledged as such in the outer organisational culture or by management. The added value that qualifies these processes to be defined as “innovative” are thus argued for along different lines than in more traditional innovation studies (e.g. studies that build on the classic...

  1. Surveillance and recipients care in stable condition

    Institute of Scientific and Technical Information of China (English)

    John J. Curtis


    @@ For decades now, transplant physicians, during follow-up of successfully transplanted renal failure patients, have ordered frequent checks of the serum creatinine and urinalysis.1 These remain commonplace tools. Blood pressure measurement is preformed on every clinic visit along with a check of body weight and a check for edema.

  2. Improved Sensitivity Relations in State Constrained Optimal Control

    Energy Technology Data Exchange (ETDEWEB)

    Bettiol, Piernicola, E-mail: [Université de Bretagne Occidentale, Laboratoire de Mathematiques (France); Frankowska, Hélène, E-mail: [Université Pierre et Marie Curie (Paris 6), CNRS and Institut de Mathématiques de Jussieu (France); Vinter, Richard B., E-mail: [Imperial College London, Department of Electrical and Electronic Engineering (United Kingdom)


    Sensitivity relations in optimal control provide an interpretation of the costate trajectory and the Hamiltonian, evaluated along an optimal trajectory, in terms of gradients of the value function. While sensitivity relations are a straightforward consequence of standard transversality conditions for state constraint free optimal control problems formulated in terms of control-dependent differential equations with smooth data, their verification for problems with either pathwise state constraints, nonsmooth data, or for problems where the dynamic constraint takes the form of a differential inclusion, requires careful analysis. In this paper we establish validity of both ‘full’ and ‘partial’ sensitivity relations for an adjoint state of the maximum principle, for optimal control problems with pathwise state constraints, where the underlying control system is described by a differential inclusion. The partial sensitivity relation interprets the costate in terms of partial Clarke subgradients of the value function with respect to the state variable, while the full sensitivity relation interprets the couple, comprising the costate and Hamiltonian, as the Clarke subgradient of the value function with respect to both time and state variables. These relations are distinct because, for nonsmooth data, the partial Clarke subdifferential does not coincide with the projection of the (full) Clarke subdifferential on the relevant coordinate space. We show for the first time (even for problems without state constraints) that a costate trajectory can be chosen to satisfy the partial and full sensitivity relations simultaneously. The partial sensitivity relation in this paper is new for state constraint problems, while the full sensitivity relation improves on earlier results in the literature (for optimal control problems formulated in terms of Lipschitz continuous multifunctions), because a less restrictive inward pointing hypothesis is invoked in the proof, and because

  3. Virtual care

    DEFF Research Database (Denmark)

    Kamp, Annette; Aaløkke Ballegaard, Stinne

    of retrenchment, promising better quality, empowerment of citizens and work that is smarter and more qualified. Through ethnographic field studies we study the introduction of virtual home care in Danish elderly care, focusing on the implications for relational work and care relations. Virtual home care entails...... and professionals, and they instigate change in organization and professional identities. Studies, which more specifically deal with telecare, stress how virtualization alters the character of the observations care workers are able to make, and how the validity of the patients’ own measurements and observations...... point out how issues of trust and surveillance, which are always negotiated in care relations, are in fact accentuated in this kind of virtual care work. Moreover, we stress that the contemporary institutional context, organization and time schedules have a vast impact on the practices developed....

  4. Who Cares for Care Leavers? (United States)

    Askew, Julie; Rodgers, Paul; West, Andrew


    This chapter describes a programme of learning and development at the University of Sheffield, United Kingdom, to support looked-after children and care leavers (youth previously provided care outside or beyond family) throughout the student lifecycle. In this context, looked-after children are those cared for by a town/city authority where…

  5. 32 CFR 564.37 - Medical care. (United States)


    ... 32 National Defense 3 2010-07-01 2010-07-01 true Medical care. 564.37 Section 564.37 National... REGULATIONS Medical Attendance and Burial § 564.37 Medical care. (a) General. The definitions of medical care; policies outlining the manner, conditions, procedures, and eligibility for care; and the sources from...

  6. Condicionantes en la utilización de los servicios de atención primaria: Evidencias empíricas e inconsistencias metodológicas Factors conditioning primary care services utilization: Empirical evidence and methodological inconsistencies

    Directory of Open Access Journals (Sweden)

    M. Sáez


    : problemas de diseño, errores de medida, errores de especificación y métodos estadísticos inadecuados. Como vías de solución citaríamos el diseño de cuasi experimentos, la utilización de grandes bases de datos administrativos, así como de fuentes de datos primarios (diseño; la distinción entre distintos tipos de utilización y entre unidades de análisis alternativas a la visita, y la corrección de errores de medida en las variables explicativas (errores de medida; la consideración de variables explicativas relevantes (errores de especificación, y la utilización de modelos multinivel (métodos estadísticos inadecuados.Introduction: In Spain, the degree and characteristics of primary care services utilization have been the subject of analysis since at least the 1980s. One of the main reasons for this interest is to assess the extent to which utilization matches primary care needs. In fact, the provision of an adequate health service for those who most need it is a generally accepted priority. Factors conditioning use: The evidence shows that individual characteristics, mainly health status, are the factors most closely related to primary care utilization. Other personal characteristics, such as gender and age, could act as modulators of health care need. Some family and/or cultural variables, as well as factors related to the health care professional and institutions, could explain some of the observed variability in primary care services utilization. Socioeconomic variables, such as income, reveal a paradox. From an aggregate perspective, income is the main determinant of utilization as well as of health care expenditure. When data are analyzed for individuals, however, income is not related to primary health utilization. Methodological inconsistencies: The situation is controversial, with methodological implications and, above all, consequences for the assessment of the efficiency in primary care utilization. Review of the literature reveals certain

  7. Chromosomal Conditions (United States)

    ... report card Careers Archives Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ... Careers Archives Health Topics Pregnancy Before or between pregnancies Nutrition, weight & fitness Prenatal care Is it safe? Labor & ...

  8. Advance care directives (United States)

    ... advance directive; Do-not-resuscitate - advance directive; Durable power of attorney - advance care directive; POA - advance care directive; Health care agent - advance care directive; Health care proxy - ...

  9. Situación y perspectivas laborales de los técnicos de salud de atención primaria de Cataluña Working conditions of public health workers in the primary care in Catalonia, Spain

    Directory of Open Access Journals (Sweden)

    Maria Salut Martínez Ferrer


    Full Text Available Objetivos: Explorar la situación laboral de los técnicos de salud adscritos a las unidades docentes de medicina de familia y comunitaria de Cataluña. Métodos: Estudio transversal. Resultados: De 53 posibles técnicos de salud, se obtuvieron 40 respuestas, 29 completas. Más de la mitad de los técnicos de salud del Institut Català de la Salut son interinos. Sus principales actividades son la docencia, el apoyo metodológico a la investigación y la evaluación de servicios y personal sanitario. Desean mayor definición de sus funciones y mejorar sus condiciones de trabajo. Aunque una pequeña proporción considera muy difícil la coordinación en la salud pública, la mayoría muestra disposición a colaborar. Conclusiones: La inestabilidad laboral, las mejoras salariales y la definición de funciones son prioritarias para los técnicos de salud. Consideran deseable la coordinación de la atención primaria con los servicios de salud pública.Objective: To describe the working conditions and tasks of health workers in the health training unit of family medicine in Catalonia, Spain. Methods: Cross-sectional study. Results: Fifty-three public health workers were located. Forty responses were obtained, of which 29 were complete. More than half the health technicians in the Catalan Health Service had temporary contracts. Their main tasks were teaching, providing methodological assistance in research, and auditing healthcare services and healthcare workers. Health technicians wanted more precise job definition and better working conditions. Although a small proportion believed coordination of primary care and public health to be very difficult, most would take part in it. Conclusions: The main issues for public health workers were work instability, better salaries, and greater job definition. Coordination between primary care and public health was considered desirable.

  10. Dimensão relacional da atividade de cuidado e condições de trabalho de auxiliares de enfermagem em uma unidade neonatal The relational dimension of the care activity and the working conditions in a neonatal unit

    Directory of Open Access Journals (Sweden)

    Letícia Pessoa Masson


    Full Text Available Este artigo analisa as condições de trabalho de auxiliares de enfermagem que atuam em Unidade Neonatal, considerando a dimensão relacional da atividade de cuidado. Tendo como principais referências epistemológicas a concepção canguilhemiana de saúde e a perspectiva ergológica, a pesquisa se pautou em abordagens clínicas do trabalhar, incluindo métodos diretos (observações, indiretos (conversas e encontros sobre o trabalho com as auxiliares e análise de documentos relativos às normas antecedentes desse trabalho. Analisou-se fundamentalmente a produção linguageira dos coletivos. Entre os resultados encontrados, destacam-se: o desenvolvimento dessa atividade de cuidado implica intensa mobilização das trabalhadoras; a possibilidade de não atender às mães que chegam para ter seus bebês parece ser mais nocivo à saúde dessas profissionais do que trabalhar com um número excessivo de pacientes. Concluiu-se que as condições precárias de trabalho são potencialmente produtoras de sofrimento patogênico, uma vez que a realização prazerosa e bem-sucedida dessa atividade é dificultada.This paper focuses on the working conditions of nursing technicians of Neonatal Units, considering the relational dimension of the care activity. Having as main epistemological references Canguilhem's concept of health of and the Ergological perspective, the research was based on the clinical approaches of work, including the following methods: direct (observations and indirect (talks and meetings about work with the technicians; analysis of documents on the previous norms concerning this work. The analysis dealt basically with the groups' language production. Some results can be highlighted: the development of this care activity implies intense mobilization of workers; the possibility of not assisting the mothers who arrive to have their babies seems to be more noxious to these technicians than to work with an overload of patients; the precarious

  11. The association between tobacco use and perceptions of tobacco price strategies within primary care patients in rural Greece

    Directory of Open Access Journals (Sweden)

    Emmanouil Symvoulakis


    The above findings imply that the reduction in tobacco use in rural Greece, is complex and a population’s sensitivity should be enhanced through primary care initiatives that are adjusted between health promotion and counseling in conditions of socioeconomic distress.

  12. Culture, palliative care and multiculturalism. (United States)

    Nyatanga, Brian


    The frequently asked question, 'Why do minority ethnic groups not access palliative care?' needs closer analysis. This article sets out to revisit the context and principles of palliative care and discuss why palliative care services are not accessed equally by all cultural groups in western, particularly UK, society. The conceptual basis of culture, together with cultural diversity, will be discussed to foster greater understanding of multiculturalism with a view to offering recommendations for the provision of culturally sensitive palliative care. These recommendations will seek to be challenging but realistic, both for practitioners providing such care and for educationalist disseminating 'knowledge'. I will highlight what I believe are the challenges of providing palliative care that is acceptable to minority ethnic groups based on personal experience and literature, and emphasize that these challenges should be seen as potential opportunities. It is hoped that this article will set a platform for honest and open discussion about the way forward in providing culturally sensitive palliative care for minority ethic groups. I will pose a challenging call to all members of minority ethnic groups to adopt a more proactive approach to their own care by preparing themselves to be in an influential position in palliative care provision through academic and clinical endeavours.

  13. Structure and organization of primary care.

    NARCIS (Netherlands)

    Lember, M.; Cartier, T.; Bourgueil, Y.; Dedeu, T.; Hutchinson, A.; Kringos, D.


    The way primary care is structured establishes important conditions for both the process of care and its outcomes. In this chapter, the structure of primary care will be discussed according to three dimensions: governance, economic conditions and workforce development. Governance refers to the visi

  14. Symptom management in palliative care and end of life care. (United States)

    Bookbinder, Marilyn; McHugh, Marlene E


    There is a need for generalist- and specialist-level palliative care clinicians proficient in symptom management and care coordination. Major factors contributing to this need include changed disease processes and trajectories, improved medical techniques and diagnostic testing, successful screening for chronic conditions, and drugs that often prolong life. The rapid progressive illnesses and deaths that plagued the first half of the twentieth century have been replaced in the twenty-first century by increased survival rates. Conditions that require ongoing medical care beyond a year define the current chronic illness population. Long years of survival are often accompanied by a reduced quality of life that requires more medical and nursing care and longer home care. This article reviews the management of selected symptoms in palliative and end of life care.

  15. Primary care for refugees. (United States)

    Eckstein, Barbara


    Over the past decade, at least 600,000 refugees from more than 60 different countries have been resettled in the United States. The personal history of a refugee is often marked by physical and emotional trauma. Although refugees come from many different countries and cultures, their shared pattern of experiences allows for some generalizations to be made about their health care needs and challenges. Before being accepted for resettlement in the United States, all refugees must pass an overseas medical screening examination, the purpose of which is to identify conditions that could result in ineligibility for admission to the United States. Primary care physicians have the opportunity to care for members of this unique population once they resettle. Refugees present to primary care physicians with a variety of health problems, including musculoskeletal and pain issues, mental and social health problems, infectious diseases, and longstanding undiagnosed chronic illnesses. Important infectious diseases to consider in the symptomatic patient include tuberculosis, parasites, and malaria. Health maintenance and immunizations should also be addressed. Language barriers, cross-cultural medicine issues, and low levels of health literacy provide additional challenges to caring for this population. The purpose of this article is to provide primary care physicians with a guide to some of the common issues that arise when caring for refugee patients.

  16. Concept caring in nursing

    Directory of Open Access Journals (Sweden)

    Lenka Drahošová


    Full Text Available Aim: The aim of this literature review was to search for qualitative studies focusing on the concept of caring in nursing, to analyse them and to synthesize knowledge that concerns the definition of the concept of caring in nursing from the point of view of nurses and patients. Design: Review. Methods: Qualitative studies were searched for systematically in the electronic databases Academic Search Complete (EBSCO, CINAHL, Medline, Science Direct, and the Wiley Library Online, according to set criteria and defined key words for the period 1970-2015. Seven selected articles were analysed after selection of documents with the aid of a sorting chart. Results: Nurses understand caring in nursing as a relationship with patients which is characterised on the nurses' part by an individual and empathetic approach, attentiveness, experience and sensitivity. Through caring, active communication takes place, providing information which reduces anxiety and leads to the breaking down of barriers. This relationship helps protect patients' autonomy, dignity and comfort. It requires experience on the part of nurses, and it is influenced by the environment. The nurses' personal qualities (what professional knowledge, attitudes and skills they have and their availability, reliability, and emotional and physical support are important to patients. Conclusion: The concept of caring is a content specific interpersonal process which is characterized by the professional knowledge, skills, personal maturity, and interpersonal sensitivity of nurses, which result in the protection, emotional support, and the meeting of bio-psycho-social needs of patients. The results of the overview study could contribute to an explanation and understanding of the nature of caring as a fundamental feature of the discipline of nursing.

  17. Generalist palliative care in hospital

    DEFF Research Database (Denmark)

    Bergenholtz, Heidi; Jarlbæk, Lene; Hølge-Hazelton, Bibi


    Background: It can be challenging to provide generalist palliative care in hospitals, owing to difficulties in integrating disease-orientedtreatment with palliative care and the influences of cultural and organisational conditions. However, knowledge on the interactionsthat occur is sparse. Aim......: a quantitative study, in whichthree independent datasets were triangulated to study the organisation and evaluation of generalist palliative care, and a qualitative,ethnographic study exploring the culture of generalist palliative nursing care in medical departments. Setting/participants: A Danish regional......: To investigate the interactions between organisation and culture as conditions for integrated palliative care in hospital and, ifpossible, to suggest workable solutions for the provision of generalist palliative care. Design: A convergent parallel mixed-methods design was chosen using two independent studies...

  18. The Insiders as Outsiders: Professionals Caring for an Aging Parent. (United States)

    Kaiser, Robert M; Kaiser, Susan L


    As professionals in geriatric medicine and social work, we are caregivers for our widowed mother of 90 years, a woman with neurocognitive disorder and multiple medical conditions. She has had repeated, problematic encounters with the health care system over the past 4 years. Caring successfully for an aging parent requires a comprehensive understanding of her unique medical, psychological, and functional status; need for social support; and overall goals of care. Poor communication between and among clinical teams-and with patients and families-is ubiquitous. The patient and family are not consistently listened to, or integrated, into the clinical team. We recount our experiences of one hospitalization and how we addressed the recurring obstacles we faced. Our training and experience gave us a firm understanding of the hazards of hospitalizing an elderly person and the need to be present, engaged, attentive, active, and vigilant. We caught and corrected major mistakes: failure to follow-up abnormal test results, multiple medication errors, undertreatment of pain, poor fall prevention, and inappropriate assessment and placement for rehabilitation. In a dysfunctional health care system, the family is, and must be, the ultimate fail-safe mechanism. We identify potentially effective solutions for the problems we encountered: adoption of dementia-sensitive and patient- and family-centered care, improved communication, better management of information (including better systems for monitoring lab results and for dispensing and reconciling medications), expediting care, changing reimbursement and regulation, and improving discharge planning and placement.

  19. Epilepsy and oral care. (United States)

    Fiske, Janice; Boyle, Carole


    Epilepsy is a common symptom of an underlying neurological disorder. The seizures can take a variety of forms. Both the condition and its medical management can affect oral health. Prevention of oral disease and carefully planned dental treatment are essential to the well-being of people with epilepsy.

  20. Multiple Chronic Conditions Among Medicare Beneficiaries... (United States)

    U.S. Department of Health & Human Services — Individuals with multiple chronic conditions (MCC) present many challenges to the health care system, such as effective coordination of care and cost containment. To...

  1. Context Sensitive Health Informatics

    DEFF Research Database (Denmark)

    Healthcare information technologies are now routinely deployed in a variety of healthcare contexts. These contexts differ widely, but the smooth integration of IT systems is crucial, so the design, implementation, and evaluation of safe, effective, efficient and easy to adopt health informatics...... involves careful consideration of both human and organizational factors. This book presents the proceedings of the Context Sensitive Health Informatics (CSHI) conference, held in Copenhagen, Denmark, in August 2013. The theme of this year’s conference is human and sociotechnical approaches. The Human......: patients and IT; usability test and evaluation; work tasks and related contexts; human factors and simulation; and context and systems design, and outline theories and models for studying contextual issues and insights related to how health information technologies can be better designed to accommodate...

  2. Public trust in health care : a performance indicator?

    NARCIS (Netherlands)

    Schee, Evelien van der; Groenewegen, Peter P.; Friele, Ronald D.


    Purpose – If public trust in health care is to be used as a performance indicator for health care systems, its measurement has to be sensitive to changes in the health care system. For this purpose, this study has monitored public trust in health care in The Netherlands over an eight-year period, fr

  3. Prenatal Care: First Trimester Visits (United States)

    ... include your partner in the appointment as well. Medical history Your health care provider will ask many questions, including details about: Your ... He or she will check for any undiagnosed medical conditions. Your health care provider will also examine your vagina and the opening ...

  4. Building the eye care team

    Directory of Open Access Journals (Sweden)

    Thulasiraj Ravilla


    Full Text Available Eye care services are people intensive. They require the right people (competence, in the right numbers (capacity, in the right mix (team with the right resources and processes (enabling conditions to ensure effective and sustainable delivery of patient care.

  5. Palliative care in home care: perceptions of occupational therapists

    Directory of Open Access Journals (Sweden)

    Séfora Gomez Portela


    Full Text Available This research aimed at understanding and reflecting on the perceptions of occupational therapists regarding the implementation of palliative care in home care. This is an exploratory, qualitative study, through semi-structured interviews, conducted in the second semester of 2012 with eight occupational therapists with experience in palliative care in the city of São Paulo. Content analysis identified four themes: characterization and professional trajectory in the field, understanding the concepts of palliative care, home care and palliative care, and occupational therapy and palliative care in home care. The results suggest that the role of the occupational therapist in this field has taken place at different levels of health care, being addressed to people with varying needs. The use of the concept of palliative care by the interviewees exceeds the notion of end of life, following the changes in the epidemiological transition. They understand that professional services follow the trend of national palliative care services with focus on specialized levels, but manifest the importance of its implementation in primary and home care. Among the barriers to practice, they identified the complexity of “being at home “, peculiarities of palliative care with high cost demands, lack of infrastructure and implementation of the current policy. Professional training and scientific roduction in the area were viewed as inadequate, although they identified a call for change. The interviewees recognized palliative care in home care as a strong professional field, but one still requiring study and discussions regarding its limits and conditions of implementation, especially in the Unified Health System.

  6. Blood Thinners and Dental Care (United States)

    ... a Doctor Patient Condition Information Publications & News OOOO Journal Newsroom Clinicians’ Guides Clinical Practice Statements Newsletters Latest ... Meeting Orlando, FL Our Partners Blood Thinners and Dental Care Many dental patients are taking “blood thinner” ...

  7. Chiropractic care for back pain (United States)

    ... this page: // Chiropractic care for back pain To use the sharing ... discussed in your first session. What Conditions Does Chiropractic Treat Best? Chiropractic treatment is most effective for: ...

  8. Children's proximal societal conditions

    DEFF Research Database (Denmark)

    Stanek, Anja Hvidtfeldt


    This article will argue for and unfold the conceptualization of children’s proximal societal conditions. Through out different research project in which children’s everyday life in different day care settings and in schools has been studied, it becomes clear that ‘the societal’ is not something t...

  9. CARES Foundation (United States)

    ... today and CARES will receive 5% of your purchase! THEIR HISTORY: In 2001, Lauren’s Hope introduced the ... Go to the staff directory Find Us on Facebook Recent Tweets In case you missed it! http:// ...

  10. Residential Care (United States)

    ... Last name: Email: * Zip: * *required We will not sell or share your name. Residential Care Tweet Bookmark ... for the future. Use Alzheimer's Navigator ™ - our free online tool - to guide you as you map out ...

  11. High sensitivity troponin and valvular heart disease. (United States)

    McCarthy, Cian P; Donnellan, Eoin; Phelan, Dermot; Griffin, Brian P; Sarano, Maurice Enriquez-; McEvoy, John W


    Blood-based biomarkers have been extensively studied in a range of cardiovascular diseases and have established utility in routine clinical care, most notably in the diagnosis of acute coronary syndrome (e.g., troponin) and the management of heart failure (e.g., brain-natriuretic peptide). The role of biomarkers is less well established in the management of valvular heart disease (VHD), in which the optimal timing of surgical intervention is often challenging. One promising biomarker that has been the subject of a number of recent VHD research studies is high sensitivity troponin (hs-cTn). Novel high-sensitivity assays can detect subclinical myocardial damage in asymptomatic individuals. Thus, hs-cTn may have utility in the assessment of asymptomatic patients with severe VHD who do not have a clear traditional indication for surgical intervention. In this state-of-the-art review, we examine the current evidence for hs-cTn as a potential biomarker in the most commonly encountered VHD conditions, aortic stenosis and mitral regurgitation. This review provides a synopsis of early evidence indicating that hs-cTn has promise as a biomarker in VHD. However, the impact of its measurement on clinical practice and VHD outcomes needs to be further assessed in prospective studies before routine clinical use becomes a reality.

  12. Caring Encounters (United States)

    Gunn, Alyson


    Children with autism may seem to not care about things or have the same range of emotions as those of us who see them and care for them. But they do have empathy and they can be taught how to communicate it, says the author, a teacher of children with autism. We simply need to listen to them, watch them, and be with them in their moment.

  13. Internações sensíveis na atenção primária como indicador de avaliação da Estratégia Saúde da Família Internaciones sensibles en la atención primaria como indicador de evaluación de la Estrategia Salud de la Familia Hospitalizations sensitive to primary care as an evaluation indicator for the Family Health Strategy

    Directory of Open Access Journals (Sweden)

    Viviane Braga Lima Fernandes


    investigated. The definition of conditions considered sensitive to primary care was based on the Ministry of Health's list. Associations shown by socioeconomic and health variables in relation to hospitalizations sensitive to primary care were analyzed using bivariate and multiple logistic regression analyses. RESULTS: The percentage of hospitalizations sensitive to primary care in the study group was 38.8% (n = 256. The variables that remained statistically associated with conditions considered sensitive to primary care were: previous hospitalization (OR = 1.62; 95% CI: 1.51;2.28; regular visits to healthcare units (OR = 2.20; 95% CI: 1.44;3.36; low schooling level (OR = 1.50; 95% CI: 1.02;2.20; health checks not performed by the family health team (OR = 2.48; 95% CI: 1.64;3.74; hospitalization requested by physicians who were not part of the family health team (OR = 2.25; 95% CI: 1.03;4.94; and age greater than or equal to 60 years (OR = 2.12; 95% CI: 1.45;3.09. CONCLUSIONS: The variables associated with hospitalizations sensitive to primary care are particularly those relating to patients, such as age, schooling level and previous hospitalization, but regular health checks outside of the Family Health Strategy doubled the likelihood of hospitalization.

  14. 重症监护病房念珠菌感染情况及药敏分析%Analysis of Candida infections and drug sensitivity in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    贾磊; 郁慧杰; 陆锦琪; 马燮峰; 刘宇婷; 张玉琦; 蔡莹


    目的:研究重症监护病房(ICU)患者念珠菌感染分布及耐药情况。方法采用回顾性研究方法,选择2011年1月至2013年12月浙江省嘉兴市第一医院ICU收治的危重病患者,收集送检的痰液、尿液、血液、腹水、胆汁等标本念珠菌培养呈阳性的资料,对3年来ICU念珠菌感染情况、阳性标本分布、不同念珠菌分布情况及对抗真菌药物的耐药性等进行分析。结果2011年至2013年ICU共入住患者2412例次,念珠菌感染407例(16.9%),3年间念珠菌感染率呈逐年上升趋势〔2011年至2013年念珠菌检出率分别为:13.4%(77/573)、16.1%(146/907)、19.7%(184/932)〕,差异有统计学意义(P<0.01)。407株念珠菌来自痰液166株(占40.8%),尿液157株(占38.6%),腹水53株(占13.0%),血液13株(占3.1%),胆汁11株(占2.7%),其他7株(占1.7%)。菌属分布主要是白色念珠菌(174株)、光滑念珠菌(131株)、热带念珠菌(83株)、近平滑念珠菌(5株)、克柔念珠菌(12株)等,也检出少见的葡萄牙念珠菌和解脂念珠菌(2株)。从2011年至2013年白色念珠菌、光滑念珠菌、热带念珠菌对氟康唑、伊曲康唑、伏立康唑等抗菌药物的耐药性2013年最高,2012年最低,对两性霉素B的耐药率均为0,对伊曲康唑的耐药率最高(分别为10.9%、27.8%、9.6%),其次是伏立康唑(分别为6.6%、11.0%、0)、氟康唑(分别为4.7%、7.4%、1.9%),近平滑念珠菌、克柔念珠菌、葡萄牙念珠菌和解脂念珠菌对两性霉素B、氟康唑、伊曲康唑、伏立康唑的耐药率均为0。结论 ICU念珠菌感染率呈上升趋势,主要集中在呼吸道和泌尿道,对伊曲康唑的耐药率最高。%Objective To study the distribution of Candida infection and drug tolerance in intensive care unit(ICU). Methods A retrospective study was conducted. The critical

  15. Final Report, The Teaching Parents Study: Pan-Britain, mixed methods study of multidisciplinary teams teaching parents, and parents learning to manage, home based care of long-term childhood kidney conditions



    Background: Care of children and young people (children) in the 12 children’s kidney units in England, Scotland and Wales is managed by multidisciplinary teams (MDTs) comprising professionals such as clinical psychologists, dieticians, doctors, nurses, pharmacists, play workers, social workers, and therapists. Within the constraints of treatment regimens it is in children’s best interests for them to be cared for at home whenever possible1-4. Professionals therefore, spend considerable time ...

  16. Integrating Palliative Care into Primary Care. (United States)

    Gorman, Rosemary D


    Improved quality of life, care consistent with patient goals of care, and decreased health care spending are benefits of palliative care. Palliative care is appropriate for anyone with a serious illness. Advances in technology and pharmaceuticals have resulted in increasing numbers of seriously ill individuals, many with a high symptom burden. The numbers of individuals who could benefit from palliative care far outweighs the number of palliative care specialists. To integrate palliative care into primary care it is essential that resources are available to improve generalist palliative care skills, identify appropriate patients and refer complex patients to specialist palliative care providers.

  17. Mental health collaborative care and its role in primary care settings. (United States)

    Goodrich, David E; Kilbourne, Amy M; Nord, Kristina M; Bauer, Mark S


    Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems, as well as engaging patients in their care through self-management support and linkages to community resources. The model is also a cost-efficient strategy for primary care practices to improve outcomes for a range of mental health conditions across populations and settings. CCMs can help achieve integrated care aims underhealth care reform yet organizational and financial issues may affect adoption into routine primary care. Notably, successful implementation of CCMs in routine care will require alignment of financial incentives to support systems redesign investments, reimbursements for mental health providers, and adaptation across different practice settings and infrastructure to offer all CCM components.

  18. Pediatric intensive care in Argentina. (United States)

    Schnitzler, E J


    8.2% of the gross domestic product is spent annually on health care in Argentina, a country of 32 million people. There is 1 medical doctor of every 147,000 beds in a total 3180 hospitals. The infant mortality rate in Argentina is 24.5/1000 live births which is high compared to developed countries. Perinatal causes and congenital anomalies are the main cause of death after the neonatal period, and accidents, cardiac disease, and respiratory tract infections are the main causes of death among children over age 1 year. Argentina has approximately 35 pediatric intensive care units (ICU), but 154 of 244 beds are within or near the capital. Only 2 hospitals have pediatric intensive care fellowship programs, so full time dedicated staff is rare. 250 registered pediatricians dedicated to intensive care are in the Argentine Pediatric Society and the nurse/bed ratio is 1:2-1:3. Moreover, the country has neither postanesthesia recuperation units, burn units, chronic ventilation units, nor approved home assistance programs, and intermediate care is not clearly standardized. These inadequacies have led to a shortage of beds and the caring for of critically ill children in general pediatric or emergency wards in hospitals which lack adequate equipment; patients are often discharged inappropriately to clear bed space. Even so, prehospital and emergency room care tends to be provided without the necessary coordination with the pediatric ICU, and structural conditions regarding electrical self-sufficiency, air conditioning, and circulation are met in only few units. Despite the existence of these adverse conditions for the care of critically ill children, a pediatric organ transplant program developed since 1987 has demonstrated 70% to 100% survival rates for 16l orthotopic liver and 9 heart transplants, respectively. Alternatives to improving intensive care in Argentina include optimizing the response of emergency and critical care delivery systems, categorizing hospitals and

  19. Pulmonary Edema Assessed by Ultrasound: Impact in Cardiology and Intensive Care Practice. (United States)

    Blanco, Pablo A; Cianciulli, Tomás F


    Pulmonary edema is a frequent condition found in adult patients hospitalized in cardiology wards and intensive care units. Ultrasonography is a diagnostic modality with a high sensitivity for the detection of extravascular lung water, visualized as B lines, and usually caused by cardiogenic or noncardiogenic pulmonary edema. This paper highlights a simple method for the assessment of patients with pulmonary edema, which allows for a differential diagnosis of its possible mechanism and contributes to therapeutic intervention guiding and monitoring.

  20. Caring for Latino patients. (United States)

    Juckett, Gregory


    Latinos comprise nearly 16 percent of the U.S. population, and this proportion is anticipated to increase to 30 percent by 2050. Latinos are a diverse ethnic group that includes many different cultures, races, and nationalities. Barriers to care have resulted in striking disparities in quality of health care for these patients. These barriers include language, lack of insurance, different cultural beliefs, and in some cases, illegal immigration status, mistrust, and illiteracy. The National Standards for Culturally and Linguistically Appropriate Services address these concerns with recommendations for culturally competent care, language services, and organizational support. Latinos have disproportionately higher rates of obesity and diabetes mellitus. Other health problems include stress, neurocysticercosis, and tuberculosis. It is important to explore the use of alternative therapies and belief in traditional folk illnesses, recognizing that health beliefs are dependent on education, socioeconomic status, and degree of acculturation. Many-but not all-folk and herbal treatments can be safely accommodated with conventional therapy. Physicians must be sensitive to Latino cultural values of simpatia (kindness), personalismo (relationship), respeto (respect), and modestia (modesty). The LEARN technique can facilitate cross-cultural interviews. Some cultural barriers may be overcome by using the "teach back" technique to ensure that directions are correctly understood and by creating a welcoming health care environment for Latino patients.

  1. Spiritual Experiences of Muslim Critical Care Nurses. (United States)

    Bakir, Ercan; Samancioglu, Sevgin; Kilic, Serap Parlar


    The purpose of this study was to determine the experiences and perceptions of intensive care nurses (ICNs) about spirituality and spiritual care, as well as the effective factors, and increase the sensitivity to the subject. In this study, we examined spiritual experiences, using McSherry et al. (Int J Nurs Stud 39:723-734, 2002) Spirituality and spiritual care rating scale (SSCRS), among 145 ICNs. 44.8% of the nurses stated that they received spiritual care training and 64.1% provided spiritual care to their patients. ICNs had a total score average of 57.62 ± 12.00 in SSCRS. As a consequence, it was determined that intensive care nurses participating in the study had insufficient knowledge about spirituality and spiritual care, but only the nurses with sufficient knowledge provided the spiritual care to their patients.

  2. Care of the body after death. (United States)

    Olausson, Jill; Ferrell, Betty R


    Care of the body after death is an important nursing function that occurs in a wide variety of contexts. After a patient dies, nursing care continues as physical care of the body as well as care of the family members. In this descriptive, qualitative study, the authors explored nurse perceptions of what it means to care for the body after death. Narratives describing this care were collected and analyzed. The descriptions were coded and two overarching themes emerged: giving respectful and dignified after-death care (ADC) that is sensitive to the needs of the family and ADC providing nurses with a mechanism for coping with care of dying patients. To ensure patient and family ADC needs are not superseded by nurses' own coping needs, comprehensive patient and family-centered ADC planning is recommend. Grief resolution opportunities, end-of-life education, and mentoring should be available to support nurses with post-death experiences.

  3. Critical issues in burn care. (United States)

    Holmes, James H


    Burn care, especially for serious burn injuries, represents a considerable challenge for the healthcare system. The American Burn Association has established a number of strategies for the management of burn patients and dedicates its efforts and resources to promoting and supporting burn-related research, education, care, rehabilitation, and prevention, often in collaboration with other organizations. The American Burn Association has recommended that patients with serious burns be referred to a designated burn center, ie, a hospital outfitted with specialized personnel and equipment dedicated to burn care. Burn centers have been operational for over 50 years, but the complexity and costs of providing specialized burn care have given rise to a number of critical administrative and political issues. These include logistical limitations imposed by the uneven national distribution of burn centers and a potential shortage of burn beds, both during everyday conditions and in the event of a mass disaster. Burn surgeon shortages have also been identified, stemming, in part, from a lack of specialized burn care training opportunities. There is currently a lack of quality outcome data to support evidence-based recommendations for burn care, and burn care centers are compromised by problems obtaining reimbursement for the care of uninsured and publicly insured out-of-state burn patients. Initiatives are underway to maintain efficient burn care facilities that are fully funded, easily accessible, and most importantly, provide optimal, evidence-based care on a daily basis, and are well-equipped to handle a surge of patients during a disaster situation.

  4. Guidelines for a Comprehensive Care Program to Ostomized Patients and Families: a Nursing proposal

    Directory of Open Access Journals (Sweden)

    Paula Alvarenga de Figueiredo


    Full Text Available Objectives: describe care needs and demands that mark the discursive practices of ostomized clients and family members and discuss guidelines for a comprehensive care program to ostomized clients and their families, organized by macrosociological categories. Method: Creative and Sensitive, involving 17 ostomized subjects and family members at a municipal outpatient clinic. The ethical aspects were complied with. A characterization form was used, as well as Creativity and Sensitivity Dynamics: "speaking map", "body-knowledge" and "calendar". Critical Discourse Analysis was applied. Results: the health needs and care demands of the ostomized patients and their family members, in their multiple dimensions, were constituted in the home and community, outpatient and social context, implying new orientations for nursing care. The unveiling of the data brought elements that constituted guidelines, in a macrosociological approach, to achieve the expanded integrality of nursing care. Conclusion: the ostomized clients are unique in their genre/peculiar from Latin sui generis, calling for strategies that respond to and distinguish their specificities. Elaborating a Public Health Policy that improves and reorganizes the care demands, taking into account these individual biopsychosocial and spiritual aspects, is a possible and irrevocable target in the attempt to achieve better conditions of health and wellbeing.

  5. Care and calls

    DEFF Research Database (Denmark)

    Paasch, Bettina Sletten

    This Ph.D. thesis focuses on key aspects of the use of mobile work phones in hospitals. In recent years, demands for efficiency improvements have been predominant in the Danish healthcare system; implementing mobile work phones has been one way of complying with this mandate. Sensitivity...... to and caring for the patient are core values in the nursing profession, and they are grounded in the relationship between nurse and patient. The aim of this thesis is to explore if and how nurses are able to enact care in patient interaction when a mobile work phone also enters the encounter. In studying...... interactions between nurses, patients, and mobile work phones, this thesis draws on several strands of practice theories to alternate between zooming in on the concrete situated actions performed and zooming out on the broader issues that help shape them. The overall theoretical and methodological framework...

  6. Wound Care. (United States)

    Balsa, Ingrid M; Culp, William T N


    Wound care requires an understanding of normal wound healing, causes of delays of wound healing, and the management of wounds. Every wound must be treated as an individual with regard to cause, chronicity, location, and level of microbial contamination, as well as patient factors that affect wound healing. Knowledge of wound care products available and when negative pressure wound therapy and drain placement is appropriate can improve outcomes with wound healing. Inappropriate product use can cause delays in healing. As a wound healing progresses, management of a wound and the bandage material used must evolve.

  7. 模拟场景下临床路径对提高院前创伤救治质量的研究%Effect of clinical pathway on promoting pre-hospital trauma care under clinical simulations condition

    Institute of Scientific and Technical Information of China (English)

    付卫林; 张军根; 袁轶俊; 唐春福; 张燕军; 张志伟


    Objective To explore the effect of clinical pathway on promoting pre-hospital trauma care under clinical simulations condition. Methods The traumatic mimic patients and pre-hospital clinical pathway were designed and the traditional traumaic treatment and clinical pathway treatment were used on simulated patients. Results After training, the percentage of locale assessment, life-threatening bleeding assessment, airway assessment, breathing assessment, circula-tion assessment, rapidly trauma assessment and communication with teammates and assistants were significantly increased (χ2=80.81, 88.17, 66.78, 55.54, 74.67, 84.41, 64.07, 74.67,P<0.05). The scores of control bleeding, dressing, cervi-cal spine immobilization, airway management were also significantly improved (t=-42.97,-35.37,-54.34,-88.75,-52.28, P<0.05). Moreover, the time of locale treatment, assessment, control bleeding and dressing, cervical spine immobiliza-tion, fracture fixation were significantly shortened than that of before training (t=4.88,12.81,6.63,3.92,4.58,P<0.05). Conclusion The clinical pathway under clinical simulations condition can improve the quality of trauma assessment, re-duce time of treatment, improve the efficiency and the quality of treatment.%目的:探讨在模拟场景下临床路径对提高院前创伤救治质量的有效程度。方法设计创伤的模拟病例场景和创伤的院前临床路径,以传统的创伤救治和临床路径的救治方式分别对模拟病例进行救治。结果培训后进行现场评估、显性大出血评估、气道评估、呼吸评估、循环评估、快速查体评估、救治沟通、协助救治的急救小组比例较培训前有明显提高(χ2分别=80.81、88.17、66.78、55.54、74.67、84.41、64.07、74.67,P均<0.05)。止血、包扎、长骨固定、颈椎固定、气道管理等各单项技能操作的成绩也较培训前明显提高(t分别=-42.97、-35.37、-54.34、-88.75、-52.28,P均<0.05

  8. [Palliative care in neurology]. (United States)

    Provinciali, Leandro; Tarquini, Daniela; De Falco, Fabrizio A; Carlini, Giulia; Zappia, Mario; Toni, Danilo


    Palliative care in neurology is characterized by the need of taking into account some distinguishing features which supplement and often differ from the general palliative approach to cancer or to severe organ failures. Such position is emphasized by a new concept of palliative assistance which is not limited to the "end of life" stage, as it was the traditional one, but is applied along the entire course of progressive, life-limiting, and disabling conditions. There are various reasons accounting for a differentiation of palliative care in neurology and for the development of specific expertise; the long duration of the advanced stages of many neurological diseases and the distinguishing features of some clinical problems (cognitive disorders, psychic disorders, etc.), in addition to the deterioration of some general aspects (nutrition, etc.), make the general criteria adopted for cancer, severe respiratory, hepatic or renal failures and heart failure inadequate. The neurological diseases which could benefit from the development of a specific palliative approach are dementia, cerebrovascular diseases, movement disorders, neuromuscular diseases, severe traumatic brain injury, brain cancers and multiple sclerosis, as well as less frequent conditions. The growing literature on palliative care in neurology provides evidence of the neurological community's increasing interest in taking care of the advanced and terminal stages of nervous system diseases, thus encouraging research, training and updating in such direction. This document aims to underline the specific neurological requirements concerning the palliative assistance.

  9. Segmenting the mental health care market. (United States)

    Stone, T R; Warren, W E; Stevens, R E


    The authors report the results of a segmentation study of the mental health care market. A random sample of 387 residents of a western city were interviewed by telephone. Cluster analysis of the data identified six market segments. Each is described according to the mental health care services to which it is most sensitive. Implications for targeting the segments are discussed.

  10. Hospice Care (United States)

    ... Hospice is a combination of services designed to address not only the physical needs of patients, but also the psychosocial needs of patients, their loved ones. Hospice combines pain control, symptom ... plan to address each patient’s individual needs. The hospice care team ...

  11. Respite Care (United States)

    ... provided in a home, an adult day-care program or over a weekend in a nursing home or an assisted living facility. For more information on the NFCSP visit the Administration on Aging website at ...

  12. Prenatal Care. (United States)

    Health Resources and Services Administration (DHHS/PHS), Rockville, MD. Office for Maternal and Child Health Services.

    This booklet is the first in a series of publications designed to provide parents with useful information about childrearing. Contents are organized into three parts. Part I focuses on the pregnancy, prenatal care, development of the baby, pregnant lifestyles, nutrition, common discomforts, and problems of pregnancy. Part II provides information…

  13. [DIE TAKING CARE]. (United States)

    Re, Cecilia


    Under the paradigm of complex thought, Edgar Morin and the pedagogy of the oppressed by Paulo Freire we describe and explain briefly the reasons of the squalid conditions in which develops the work of caring, which is not only an art and a science. The review of scientific literature, as well as the stories of life, support the need for a pedagogical reference change in vocational training programs.

  14. Achieving Excellence in Palliative Care: Perspectives of Health Care Professionals

    Directory of Open Access Journals (Sweden)

    Margaret I Fitch


    Full Text Available Caring for individuals at the end of life in the hospital environment is a challenging proposition. Understanding the challenges to provide quality end of life care is an important first step in order to develop appropriate approaches to support and educate staff members and facilitate their capacity remaining "caring." Four studies were undertaken at our facility to increase our understanding about the challenges health professionals experience in caring for patients at end of life and how staff members could be supported in providing care to patients and families: (1 In-depth interviews were used with cancer nurses (n = 30 to explore the challenges talking about death and dying with patients and families; (2 Surveys were used with nurses (n = 27 and radiation therapists (n = 30 to measure quality of work life; (3 and interprofessional focus groups were used to explore what it means "to care" (five groups held; and (4 interprofessional focus groups were held to understand what "support strategies for staff" ought to look like (six groups held. In all cases, staff members confirmed that interactions concerning death and dying are challenging. Lack of preparation (knowledge and skill in palliative care and lack of support from managers and colleagues are significant barriers. Key strategies staff members thought would be helpful included: (1 Ensuring all team members were communicating and following the same plan of care, (2 providing skill-based education on palliative care, and (3 facilitating "debriefing" opportunities (either one-on-one or in a group. For staff to be able to continue caring for patients at the end of life with compassion and sensitivity, they need to be adequately prepared and supported appropriately.

  15. Reliability of medical audit in quality assessment of medical care

    Directory of Open Access Journals (Sweden)

    Camacho Luiz Antonio Bastos


    Full Text Available Medical audit of hospital records has been a major component of quality of care assessment, although physician judgment is known to have low reliability. We estimated interrater agreement of quality assessment in a sample of patients with cardiac conditions admitted to an American teaching hospital. Physician-reviewers used structured review methods designed to improve quality assessment based on judgment. Chance-corrected agreement for the items considered more relevant to process and outcome of care ranged from low to moderate (0.2 to 0.6, depending on the review item and the principal diagnoses and procedures the patients underwent. Results from several studies seem to converge on this point. Comparisons among different settings should be made with caution, given the sensitivity of agreement measurements to prevalence rates. Reliability of review methods in their current stage could be improved by combining the assessment of two or more reviewers, and by emphasizing outcome-oriented events.

  16. FastStats: Hospice Care (United States)

    ... Day Services Centers Home Health Care Hospice Care Nursing Home Care Residential Care Communities Screenings Mammography Pap Tests Disability ... Care National Study of Long-Term Care Providers Nursing Home Care Residential Care Communities Centers for Medicare and Medicaid ...

  17. Developing a web 2.0 diabetes care support system with evaluation from care provider perspectives. (United States)

    Lin, Yung-Hsiu; Chen, Rong-Rong; Guo, Sophie Huey-Ming; Chang, Hui-Yu; Chang, Her-Kun


    Diabetes is a life-long illness condition that many diabetic patients end up with related complications resulted largely from lacking of proper supports. The success of diabetes care relies mainly on patient's daily self-care activities and care providers' continuous support. However, the self-care activities are socially bounded with patient's everyday schedules that can easily be forgotten or neglected and the care support from providers has yet been fully implemented. This study develops a Web 2.0 diabetes care support system for patients to integrate required self-care activities with different context in order to enhance patient's care knowledge and behavior adherence. The system also supports care managers in a health service center to conduct patient management through collecting patient's daily physiological information, sharing care information, and maintaining patient-provider relationships. After the development, we evaluate the acceptance of the system through a group of nursing staffs.

  18. Workshop: integration of care at the interface of primary and secondary care: work in progress.

    NARCIS (Netherlands)

    Zee, J. van der


    Background and aim: Existing health care arrangements do not always provide a well-organized response to health problems occurring in society. Inadequate coordination of care for people with chronic conditions or elderly in need for home care services provide examples of important integration issues

  19. Defining and measuring integrated patient care: promoting the next frontier in health care delivery.

    NARCIS (Netherlands)

    Singer, S.J.; Burgers, J.S.; Friedberg, M.; Rosenthal, M.B.; Leape, L.; Schneider, E.


    Integration of care is emerging as a central challenge of health care delivery, particularly for patients with multiple, complex chronic conditions. The authors argue that the concept of "integrated patient care" would benefit from further clarification regarding (a) the object of integration and (b

  20. Preparation of poly(3,4-ethylenedioxythiophene) nanofibers modified pencil graphite electrode and investigation of over-oxidation conditions for the selective and sensitive determination of uric acid in body fluids

    Energy Technology Data Exchange (ETDEWEB)

    Özcan, Ali, E-mail:; İlkbaş, Salih


    In this study, we have performed the preparation of over-oxidized poly(3,4-ethylenedioxythiophene) nanofibers modified pencil graphite electrode (Ox-PEDOT-nf/PGE) to develop a selective and sensitive voltammetric uric acid (UA) sensor. It was noted that the over-oxidation potential and time had a prominent effect on the UA response of the Ox-PEDOT-nf/PGE. Characterizations of PEDOT-nf/PGE and Ox-PEDOT-nf/PGE have been performed by cyclic voltammetry, electrochemical impedance spectroscopy, scanning electron microscopy, Fourier transform infrared spectroscopy and Raman spectroscopy. The highest voltammetric response of UA was obtained at pH 2.0. A linear relationship between the concentration of UA and oxidation peak currents was observed in the concentration range of 0.01–20.0 μM. The detection limit (1.3 nM according to S/N = 3) and reproducibility (RSD: 4.6 % for N:10) have also been determined. The effects of different substances on the determination of UA have been investigated. A very high peak separation value of 423 mV was obtained between UA and ascorbic acid which is the major interfering substance for UA. The use of Ox-PEDOT-nf/PGE has been successfully tested in the determination of UA in human blood serum and urine samples for the first time in the literature. - Highlights: • Modification of pencil graphite with over-oxidized PEDOT nanofibers was performed. • The prepared electrodes were used in the voltammetric determination of uric acid. • The over-oxidation potential and time has a prominent effect on the responses. • A very high peak separation (463 mV) was obtained between ascorbic and uric acids. • Analytical application of the electrodes was successfully tested in real samples.

  1. Longitudinal Magnetic Resonance Imaging-Based Assessment of Vascular Changes and Radiation Response in Androgen-Sensitive Prostate Carcinoma Xenografts under Androgen-Exposed and Androgen-Deprived Conditions

    Directory of Open Access Journals (Sweden)

    Kathrine Røe


    Full Text Available Prostate cancer (PCa patients receive androgen-deprivation therapy (ADT to reduce tumor burden. However, complete eradication of PCa is unusual, and recurrent disease is evident within approximately 2 years in high-risk patients. Clinical evidence suggests that combining ADT with radiotherapy improves local control and disease-free survival in these patients compared with radiotherapy alone. We investigated whether vascularization of androgen-sensitive PCa xenografts changed after ADT and whether such therapy affected radiation response. CWR22 xenografts received combinations of ADT by castration (CWR22-cas and 15 Gy of single-dose irradiation. At a shortest tumor diameter of 8 mm, vascularization was visualized by dynamic contrast-enhanced magnetic resonance imaging before radiation and 1 and 9 days after radiation. Voxel-wise quantitative modeling of contrast enhancement curves extracted the hemodynamic parameter Ktrans, reflecting a combination of permeability, density, and blood flow. Tumor volumes and prostate-specific antigen (PSA were monitored during the experiment. The results showed that Ktrans of CWR22-cas tumors 36±4 days after ADT was 47.1% higher than Ktrans of CWR22 tumors (P = .01. CWR22-cas tumors showed no significant changes in Ktrans after radiation, whereas Ktrans of CWR22 tumors at day 1 decreased compared with pretreatment values (P = .04 before a continuous increase from day 1 to day 9 followed (P = .01. Total PSA in blood correlated positively to tumor volume (r = 0.59, P < .01. In conclusion, androgen-exposed xenografts demonstrated radiation-induced reductions in vascularization and tumor volumes, whereas androgen-deprived xenografts showed increased vascularization and growth inhibition, but no significant additive effect of radiation.

  2. [Information security in health care]. (United States)

    Ködmön, József; Csajbók, Zoltán Ernő


    Doctors, nurses and other medical professionals are spending more and more time in front of the computer, using applications developed for general practitioners, specialized care, or perhaps an integrated hospital system. The data they handle during healing and patient care are mostly sensitive data and, therefore, their management is strictly regulated. Finding our way in the jungle of laws, regulations and policies is not simple. Notwithstanding, our lack of information does not waive our responsibility. This study summarizes the most important points of international recommendations, standards and legal regulations of the field, as well as giving practical advices for managing medical and patient data securely and in compliance with the current legal regulations.

  3. Living Conditions and Care Service Needs of the Elderly People in Urban Communities:Take the City of Langfang for Example%城市社区老年人生活状况及养老服务需求研究--以廊坊市为例

    Institute of Scientific and Technical Information of China (English)



    近十年,廊坊市老龄人口比例呈现不断上升趋势,市区老年人口结构呈现金字塔形,已经进入老年人口快速增长阶段,面临诸多的养老问题。通过对廊坊城市社区老年人生活状况及养老服务需求进行调查分析可以发现,家庭养老虽然弱化但仍是主流养老方式,社会化养老服务缺口大、层级较低,居家养老服务有很大发展潜力。%Over the past decade, the proportion of the aging population presents a rising trend in Langfang, with the urban elderly pop-ulation showing a pyramid structure and rapid growth, and many elderly service issues have appeared. Investigation and analysis of the living conditions and care service needs of the elderly people in urban communities has found that although family support is gradually weakening, it still is the mainstream of elderly care service. There is a large gap and low level in social elderly care service. Therefore, residential elderly care service has great potential for development.

  4. 25 CFR 20.331 - What is Adult Care Assistance? (United States)


    ... SOCIAL SERVICES PROGRAMS Direct Assistance Adult Care Assistance § 20.331 What is Adult Care Assistance... require personal care and supervision due to advanced age, infirmity, physical condition, or mental... 25 Indians 1 2010-04-01 2010-04-01 false What is Adult Care Assistance? 20.331 Section...

  5. Careful science?

    DEFF Research Database (Denmark)

    Jespersen, Astrid P; Bønnelycke, Julie; Eriksen, Hanne Hellerup


    Concern about obesity has prompted numerous public health campaigns that urge people to be more physically active. The campaigns often include normative statements and attempt to impose restrictions on individuals' lives without considering the complexities of daily life. We suggest that broadening...... into different exercise groups. In this article we analyse the scientific work of the trial as representing entangled processes of bodywork, where data are extracted and objectified bodies are manipulated and care practices address the emotional, social and mundane aspects of the participants' everyday lives...

  6. Medical Care during Pregnancy (United States)

    ... 1- to 2-Year-Old Medical Care During Pregnancy KidsHealth > For Parents > Medical Care During Pregnancy A ... both moms and their babies. Prenatal Care Before Pregnancy Prenatal care should start before you get pregnant. ...

  7. Home Care Services (United States)

    Home care is care that allows a person with special needs stay in their home. It might be for people who are getting ... chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help with ...

  8. What is palliative care? (United States)

    Comfort care; End of life - palliative care; Hospice - palliative care ... The goal of palliative care is to help people with serious illnesses feel better. It prevents or treats symptoms and side effects of disease and ...

  9. Standardized care plan of postpartum mastitis

    Directory of Open Access Journals (Sweden)

    Maria Ángeles Carrasco García


    Full Text Available Introduction: Puerperal mastitis or mastitis Breastfeeding is a postpartum condition that represents one of the main reasons for abandoning breastfeeding. Mainly usually occurs between weeks 2 and 3 ª postpartum. The scientific evidence confirms that the stop breastfeeding before an attack of mastitis is not conducive to recovery and that of exclusive breastfeeding and no restrictions are effective measures to prevent milk stasis and the spread of infection.Objective: The main objective is to unify criteria for the care and integrated health care levels of care through continuity of care to promote breast-specific care to prevent the emergence of this disease.Methodology: Development of a standardized care plan to enable effective communication between professionals and implementation of quality care.Conclusions: The midwife and the nurse plays an important role in identifying those women with early-onset symptoms of postpartum mastitis in the middle, both in the maternity ward and in the primary care clinic.

  10. Classical conditioning and pain: conditioned analgesia and hyperalgesia. (United States)

    Miguez, Gonzalo; Laborda, Mario A; Miller, Ralph R


    This article reviews situations in which stimuli produce an increase or a decrease in nociceptive responses through basic associative processes and provides an associative account of such changes. Specifically, the literature suggests that cues associated with stress can produce conditioned analgesia or conditioned hyperalgesia, depending on the properties of the conditioned stimulus (e.g., contextual cues and audiovisual cues vs. gustatory and olfactory cues, respectively) and the proprieties of the unconditioned stimulus (e.g., appetitive, aversive, or analgesic, respectively). When such cues are associated with reducers of exogenous pain (e.g., opiates), they typically increase sensitivity to pain. Overall, the evidence concerning conditioned stress-induced analgesia, conditioned hyperalagesia, conditioned tolerance to morphine, and conditioned reduction of morphine analgesia suggests that selective associations between stimuli underlie changes in pain sensitivity.

  11. [Non-celiac gluten sensitivity]. (United States)

    Hoffmanová, Iva; Sánchez, Daniel


    Non-celiac gluten sensitivity has recently been recognized by the scientific community as a part of gluten-related disorders, and is defined as a condition with gastrointestinal and/or extra-intestinal symptoms triggered by gluten ingestion in the absence of celiac disease and wheat allergy. Currently, there is no specific serological marker and non-celiac gluten sensitivity remains a diagnosis of exclusion: testing for celiac disease and wheat allergy must be negative, symptoms must improve with a gluten-free diet, and diagnosis must be confirmed by the gluten challenge. In this article, we discuss current knowledge of pathophysiology, clinical and epidemilogical spectrum, diagnosis, and treatment of NCGS.

  12. Health care-associated hepatitis C virus infection. (United States)

    Pozzetto, Bruno; Memmi, Meriam; Garraud, Olivier; Roblin, Xavier; Berthelot, Philippe


    Hepatitis C virus (HCV) is a blood-borne pathogen that has a worldwide distribution and infects millions of people. Care-associated HCV infections represented a huge part of hepatitis C burden in the past via contaminated blood and unsafe injections and continue to be a serious problem of public health. The present review proposes a panorama of health care-associated HCV infections via the three mode of contamination that have been identified: (1) infected patient to non-infected patient; (2) infected patient to non-infected health care worker (HCW); and (3) infected HCW to non infected patient. For each condition, the circumstances of contamination are described together with the means to prevent them. As a whole, the more important risk is represented by unsafe practices regarding injections, notably with the improper use of multidose vials used for multiple patients. The questions of occupational exposures and infected HCWs are also discussed. In terms of prevention and surveillance, the main arm for combating care-associated HCV infections is the implementation of standard precautions in all the fields of cares, with training programs and audits to verify their good application. HCWs must be sensitized to the risk of blood-borne pathogens, notably by the use of safety devices for injections and good hygiene practices in the operating theatre and in all the invasive procedures. The providers performing exposed-prone procedures must monitor their HCV serology regularly in order to detect early any primary infection and to treat it without delay. With the need to stay vigilant because HCV infection is often a hidden risk, it can be hoped that the number of people infected by HCV via health care will decrease very significantly in the next years.

  13. 用显示器测量办公亮度环境下的人眼对比度敏感视觉特性%Measurement Contrast Sensitivity of Human Vision System under Different Office Ambience Luminance Condition on the CRT Display

    Institute of Scientific and Technical Information of China (English)



    对比度敏感是描述人眼视觉系统空间特性的主要指标之一,对比度敏感函数是反映不同条件下的对比度敏感与空间频率之间的关系.人眼对比度敏感数据的测量受到环境亮度较大的影响,为了研究常用办公环境条件下的人眼对比度敏感情况,对6位青年在环境亮度分别为153,312,470 cd/m2和暗室条件下,在距离为2米处观测11种空间频率的矩形光栅进行测量,光栅用显示器进行显示,其平均亮度分别为60和90 cd/m2.实验结果表明,对于相同频率的光栅,人眼对比度敏感程度随着环境亮度的增加而减小,而且人眼在暗室环境下比在办公环境条件下对亮度光栅更敏感;但是在观测平均亮度为60cd/m2的光栅时,人眼特殊地对在环境亮度为312 cd/m2的条件下更敏感.%The contrast sensitivity function (CSF) is one of important and special spatial characteristics of human vision system,which is to reflect the relation between the contrast sensitivity under different viewing condition and spatial frequency.Ambient luminance had much influence on the contrast sensitivity in the measurements.In order to investigate how the luminance of office lighting surround to a visual target affected the measurement of contrast sensitivity to rectangular gratings,six healthy young were examined under the ambient luminance of 153,312,470 cd/m2 and the dark room condition.Measurements were carried out on a CRT monitor for 11 spatial frequencies at a viewing distance of 2m.Tested grating patterns were with two kinds of average luminance of 60 and 90 cd/m2.Measurements results show that contrast sensitivity is reduced with ambient luminance increasing,and all contrast sensitivity under the lighting viewing condition was much smaller than one under the dark room viewing condition for the same frequency,but distinguishingly,observers are the most sensitive to gratings under the surround with the luminance of 312 cd/m2 when viewing

  14. Telementoring Primary Care Clinicians to Improve Geriatric Mental Health Care. (United States)

    Fisher, Elisa; Hasselberg, Michael; Conwell, Yeates; Weiss, Linda; Padrón, Norma A; Tiernan, Erin; Karuza, Jurgis; Donath, Jeremy; Pagán, José A


    Health care delivery and payment systems are moving rapidly toward value-based care. To be successful in this new environment, providers must consistently deliver high-quality, evidence-based, and coordinated care to patients. This study assesses whether Project ECHO(®) (Extension for Community Healthcare Outcomes) GEMH (geriatric mental health)-a remote learning and mentoring program-is an effective strategy to address geriatric mental health challenges in rural and underserved communities. Thirty-three teleECHO clinic sessions connecting a team of specialists to 54 primary care and case management spoke sites (approximately 154 participants) were conducted in 10 New York counties from late 2014 to early 2016. The curriculum consisted of case presentations and didactic lessons on best practices related to geriatric mental health care. Twenty-six interviews with program participants were conducted to explore changes in geriatric mental health care knowledge and treatment practices. Health insurance claims data were analyzed to assess changes in health care utilization and costs before and after program implementation. Findings from interviews suggest that the program led to improvements in clinician geriatric mental health care knowledge and treatment practices. Claims data analysis suggests that emergency room costs decreased for patients with mental health diagnoses. Patients without a mental health diagnosis had more outpatient visits and higher prescription and outpatient costs. Telementoring programs such as Project ECHO GEMH may effectively build the capacity of frontline clinicians to deliver high-quality, evidence-based care to older adults with mental health conditions and may contribute to the transformation of health care delivery systems from volume to value.

  15. Palliative wound care: principles of care. (United States)

    Dale, Barbara; Emmons, Kevin R


    Home care nursing occurs in a complex care environment. Nurses working in this setting care for a wide array of individuals who often are sicker and more complex than ever before. The high prevalence of wounds among these individuals requires that home care nurses have a certain level of knowledge to provide excellent care. Many times, individuals with wounds do not have the capacity to heal or are burdened with numerous symptoms affecting quality of life. In these cases, the home care nurse must understand concepts of palliative wound care to alleviate symptoms with the goal of improving quality of life.

  16. Tooth sensitivity: mechanisms and management. (United States)

    Markowitz, K


    Tooth sensitivity is a common complaint encountered in clinical practice. Exposed superficial dentin is free of nerve endings, yet sensitive. Experimental evidence indicates that stimuli, such as probing the dentin surface and air blasts, induce fluid movements in the dentinal tubules and these fluid movements, in turn, activate the intradental nerves. The condition of the dentin surface is critically important in allowing this process. In addition, the internal environment of the pulp may influence nerve excitability. Therapies for tooth sensitivity include both agents that obstruct the dentinal tubules and agents that can decrease the excitability of the intradental nerves. The exact treatment used depends on the etiology of the individual's problem and the extent of dentinal tissue damage.

  17. How to achieve care coordination inside health care organizations

    DEFF Research Database (Denmark)

    Prætorius, Thim; Becker, Markus


    Understanding how health care organizations can achieve care coordination internally is essential because it is difficult to achieve, but essential for high quality and efficient health care delivery. This article offers an answer by providing a synthesis of knowledge about coordination from...... organization theory, where coordination is a central research topic. The article focuses on intra-organizational coordination, which is challenging especially across boundaries such as departments or professions. It provides an overview of the classic coordination mechanisms, e.g., standardization of work...... processes, but also of recent insights that have identified the conditions that are required to achieve coordination, and how these conditions can be provided by formal mechanisms such as standardization, but also informally by drawing on features of the emerging situation. Such research highlights...

  18. Integrated care pathways and task shifting

    Directory of Open Access Journals (Sweden)

    Linda Panton


    Full Text Available Delivery of HIV care has evolved over the last 10 years, and nurse specialists are a driving force in developing new pathways to enhance patient care. Despite the continued rise in numbers of people living with HIV, the financial constraints on the NHS have unfortunately resulted in a reduction in service provision. Experienced nurses are integral to patient care management. They not only provide standardized care for stable patients, therefore increasing consultant capacity for the more complex medical patient, but have a degree of flexibility that allows newly diagnosed patients quick access to care and support. With a strong emphasis being placed on an integrated and collaborative multidisciplinary team approach, to ensure patients receive the same standard of care, Scotland's HIV centres follow an integrated care pathway. The nurse oversees the completion of this document and co-ordinates the pathway of care depending on the clinical need. Nurses develop and maintain necessary partnerships between primary care, specialist care, psychological services, social care and third sector support services. The nurse case load continues to expand and diversify. Stable patients may be maintained on therapy but are living with a stigmatized long-term chronic condition and rely on the nurse as a point of contact to access advice and support readily. The more chaotic and vulnerable clients with complex care needs require the nurse to co-ordinate their care, ensuring the appropriate agencies remain involved. Overseeing the transition of care to other units and tracing patients who are lost to follow up is also a necessity, as retention in care is paramount for the continued improvement in clinical outcomes. The contribution that specialist nurses make to the provision of HIV care is valuable and will continue to play a large role in the delivery of such care.

  19. [Promoting citizenship through nursing care]. (United States)

    Backes, Dirce Stein; Backes, Marli Stein; Erdmann, Alacoque Lorenzini


    This study is the result of the project: networks care and social entrepreneurship: the autonomy and social commitment of nurses. The purpose of this qualitative study is to comprehend the meaning of nursing care as a social enterprising practice. The Grounded Theory was used as a methodological reference and the interview, conducted with 35 participants as technique of data collection. Data codification led to the central theme: Viewing Nursing Care as a Social Enterprising Practice. This theme is complemented by the category, characterized the cause condition: the social integration through the creation a political identity that expresses your involvement. The results showed that is necessary to learn and have a deep dialogic knowledge. In order to consolidate popular participation as a citizenship ideal, a critical professional attitude, base don the combination of care with liberty, participation end autonomy.

  20. Culture-sensitive psychotraumatology

    Directory of Open Access Journals (Sweden)

    Ulrich Schnyder


    Full Text Available Background: Although there is some evidence of the posttraumatic stress disorder (PTSD construct's cross cultural validity, trauma-related disorders may vary across cultures, and the same may be true for treatments that address such conditions. Experienced therapists tailor psychotherapy to each patient's particular situation, to the nature of the patient's psychopathology, to the stage of therapy, and so on. In addition, culture-sensitive psychotherapists try to understand how culture enhances the meaning of their patient's life history, the cultural components of their illness and help-seeking behaviors, as well as their expectations with regard to treatment. We cannot take for granted that all treatment-seeking trauma survivors speak our language or share our cultural values. Therefore, we need to increase our cultural competencies. Methods: The authors of this article are clinicians and/or researchers from across the globe, working with trauma survivors in various settings. Each author focused on one or more specific cultural aspects of working with trauma survivors and highlighted the following aspects. Results: As a result of culture-specific individual and collective meanings linked to trauma and trauma-related disorders survivors may be exposed to (self-stigma in the aftermath of trauma. Patients who are reluctant to talk about their traumatic experiences may instead be willing to write or use other ways of accessing the painful memories such as drawing. In other cultures, community and family cohesion are crucial elements of recovery. While awareness of culture-specific aspects is important, we also need to beware of premature cultural stereotyping. When disseminating empirically supported psychotherapies for PTSD across cultures, a number of additional challenges need to be taken into account: many low and middle income countries have very limited resources available and suffer from a poor health infrastructure. Conclusions: In summary